Policlinico Tor Vergata

This study investigates liquid sloshing in a rectangular tank equipped with horizontal flexible baffles to understand their influence on sloshing mitigation and intricate fluid-structure interaction (FSI) phenomena. A two-way coupled FSI model was developed using the Finite Element Method (FEM) for structural analysis and Finite Volume Method (FVM) with the Volume Of Fluid (VOF) formulation for fluid dynamics, employing a partitioned coupling strategy. Numerical decay tests explored dynamic behavior by varying baffle Young’s modulus and submergence levels. Enstrophy evolution was investigated as a robust indicator for quantifying energy dissipation associated with vortex dynamics, and a reduced-order acoustic-structural model was benchmarked as a tool for predicting fundamental frequency shifts. The FSI simulation methodology was validated against experimental results from previous literature, showing close agreement. Key outcomes reveal that baffle stiffness critically governs system response, with appropriate flexibility significantly enhancing damping performance. For submerged baffles, increasing flexibility led to optimal damping driven by maximal vortex-induced energy loss. Conversely, shallow baffles showed superior damping with rigid configurations, primarily due to pressure drag rather than vortex dynamics. While initial conditions introduced transient nonlinearities with flexible baffles, overall trends for damping and frequency remained consistent. The simplified frequency-prediction model was reliable for practical flexibility ranges, but less accurate for extreme flexibility. Overall, this work deepens understanding of how baffle characteristics influence slosh mitigation, offering valuable guidance for anti-sloshing device engineering.

Psoriasis is a chronic inflammatory skin disease associated with significant physical and psychological burden. Tildrakizumab, an interleukin-23 p19 inhibitor, has demonstrated efficacy in treating moderate-to-severe plaque psoriasis both in clinical trials and real-world setting. However, limited data are available on the impact of the effective treatment of psoriasis on the psychological health of patients. The aim of this study was to assess changes in psychological well-being, as well as clinical and quality-of-life outcomes, in patients with moderate-to-severe plaque psoriasis treated with tildrakizumab in routine clinical practice in Italy. This was an interim analysis (IA) of a 52-week multicenter, prospective, observational study. Adults with moderate-to-severe plaque psoriasis initiating tildrakizumab were enrolled. Endpoints focused on well-being and psychological health and included changes, from baseline to week28, in Depression, Anxiety, and Stress Scale-21 (DASS-21) scores, Dermatology Life Quality Index (DLQI), European Social Survey (ESS) items, and World Health Organization-Five Well-Being Index (WHO-5). Effectiveness was also monitored via Psoriasis Area and Severity Index (PASI), and safety via treatment-emergent adverse event reporting. A total of 115 patients were included (mean age 52.5years, 60.8% male), 102 receiving ≥ 1 dose of tildrakizumab and completing DASS-21 evaluations at baseline and week28. At week28, improvements were observed in DASS-21 subscales [depression (-2.6, 95%CI -2.0 to -1.0), anxiety (-2.3, 95%CI -2.0 to -1.0), and stress (-3.4, 95%CI -4.0 to -2.0)], accompanied by marked PASI reduction (-13.7, 95%CI -12.8 to -10.1). DLQI, ESS, and WHO-5 scores also improved. Adverse events were generally mild or moderate, with no unexpected safety signals. In this real-world IA, tildrakizumab was observed to improve the psychological well-being of patients, reflected by a reduction in all items of the DASS-21 scale and, in parallel, confirmed its effectiveness in managing physical symptoms of psoriasis, establishing its role in the holistic management of psoriasis.

The bidirectional relationship between epilepsy and sleep is well established. People with epilepsy frequently experience sleep and wake disturbances, which may be more frequent in older adults. With 15%-20% of epilepsy cases presenting as late-onset epilepsy of unknown etiology (LOEU), this study aimed to assess subjective sleep quality and daytime sleepiness in LOEU patients compared to older adults without neurological and psychiatric diseases. This observational study included 78 LOEU patients (55.1% males, mean age 68.29 ± 8.01 y.o.) diagnosed at Epilepsy Centers in Rome Tor Vergata, Perugia, and Chieti, and 55 older controls (38.2% males, mean age 69.76 ± 14.99 y.o.). Patients and controls completed the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI), and a subgroup of patients also answered the Quality of Life in Epilepsy Inventory (QOLIE-31) and the Beck Depression Inventory-II (BDI-II). Following the adjustment for age and epilepsy centers, LOEU patients showed significantly poorer global sleep quality (p = .046) and lower sleep quality and efficiency (p < .001) compared to controls. ESS scores were similar between groups. Patients with generalized seizures reported lower sleep quality than patients with other types of seizures. BDI-II scores correlated positively with poor sleep quality and negatively with quality of life. LOEU patients reported lower subjective sleep quality than older controls. Sleep disturbances correlated with depressive symptoms, which in turn were associated with a more impaired quality of life. These findings highlight the importance of addressing sleep issues in this population to prevent seizure recurrence and to improve well-being and quality of life.

Lateral extra-articular tenodesis (LET) combined with anterior cruciate ligament reconstruction (ACLR) has been shown to reduce graft failure. While the benefits of techniques such as the modified Lemaire procedure and anterolateral ligament reconstruction are well documented, the literature on other LET techniques is more limited. To evaluate the clinical outcomes and risk factors for failure in patients undergoing ACLR combined with LET using the Coker-Arnold modification of the MacIntosh technique. Case series; Level of evidence, 4. This retrospective case series included patients who underwent primary ACLR using a hamstring tendon autograft along with concurrent LET at a single institution between 2013 and 2022. Clinical evaluations included subjective outcome measures (International Knee Documentation Committee [IKDC] score, Knee Injury and Osteoarthritis Outcome Score [KOOS], Lysholm score, and Tegner score) and objective KT-1000 arthrometer testing. Risk factors for graft failure were identified using multivariate logistic regression. The final study cohort consisted of 328 patients. At a mean follow-up of 72.4 ± 30.3 months, 11 patients (3.4%) experienced graft failure. The mean side-to-side difference according to the KT-1000 arthrometer was 1.45 ± 1.04 mm. Patients showed excellent outcomes, with 91.5% achieving the patient acceptable symptom state (PASS) for the IKDC score and >90.0% achieving the PASS for all KOOS subscales, except for the Activities of Daily Living subscale (79.6%). High Tegner scores (≥8) and the presence of chondral lesions were independently associated with graft failure (odds ratio, 6.82 and 5.89, respectively; P < .01). Age, sex, pivot-shift grade, meniscal status, and timing of surgery were not predictive of failure. Combined ACLR and LET using the Coker-Arnold modification of the MacIntosh technique led to a 3.4% failure rate at a mean follow-up of >5 years. Higher Tegner scores and the presence of chondral lesions were found to be independently associated with reruptures.

Acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) relapse is the most frequent cause of allogeneic stem cell transplantation (allo-SCT) failure. The utility of post-relapse therapy is controversial due to the high incidence of toxicity and the low efficacy. This sub-analysis of the Gruppo Italiano Trapianto di Midollo Osseo (GITMO) AML/MDS relapse study focuses on 647 AML/MDS relapsing after allo-SCT performed between 2015 and 2021. Following the relapse, these patients were treated with either hypomethylating agents (HMAs)-based therapy (n = 308) or other treatments (n = 339), including intensive chemotherapy, FLT3-inhibitors, and second allo-SCT. HMAs-based therapies were more frequently used in older patients, transplanted not in CR following a reduced-intensity conditioning regimen. The overall response rate (ORR) with or without HMA-based salvage treatment was 33% and 40%, respectively (P = .006). The complete remission (CR) rate was 23% and 33% in the two groups, respectively (P < .001). The long-term OS and TRM of the two groups were superimposable. Independently from the type of salvage, an advantage in OS was observed when donor lymphocytes infusion (DLI) was included (P < .001). Relapse within 12 months after SCT, low disease burden at relapse, and the CR status at transplant confirmed their independent strong prognostic impact on both HMA and non-HMA-based group (HR 0.05, 0.44, and 0.49 and HR 0.19, 0.32, and 0.53, respectively). Despite the lower ORR observed with HMA-based therapy, the long-term OS was comparable to that observed with other therapies. The immune control of the disease relapse with DLI is of benefit, independently from the salvage therapy. .

In the modern era, breast surgery aims to adopt conservative strategies that ensure both oncological safety and aesthetic outcomes. However, one of the major challenges is the risk of positive margins, which may require a second surgery. Various strategies have been adopted to minimize this risk. The most commonly used strategies include the selective resection of suspicious margins after intraoperative evaluation and the routine circumferential resection of additional tissue around the cavity left by a lumpectomy, known as the Cavity-Shave (CS) Technique. A blind randomized clinical trial was conducted, in which standard selective margin resections were compared to the CS technique, in a 1:1 ratio, comparing oncological outcomes, aesthetic results, and surgical time. A total of 185 patients were enrolled in the study, with a mean age of 62.04±14.02. The sample was randomly assigned to two groups: 91(49.2%) were allocated to the cavity shave (CS) Group and 94 (50.8%) to the no-CS-Group. The rate of positive margins was 20.9% versus 18.1%, p-value:0.631 vs p-value:0.577. The re-excision rate was 12.1% vs 14.9%, in the CS-group and in the no-Cs-Group respectively. The mean operating room occupancy time was 77.9±23.5min in the CS-group versus 95.6±34.9min in the no-Cs-Group, with a p-value<0.001. Aesthetic outcomes were comparable between the two groups (p-value:0.706), despite a statistically significant difference in the total volume excised, 67.2±16.4cm3 in the CS-Group versus 51.5±17.2cm3 in the no-CS-Group, p-value:0.021. CS and selective margin resection with intraoperative histopathological evaluation showed similar oncological and aesthetic outcomes; however, CS was associated with a statistically significant reduction in surgical time.

No previous study described adolescents and young adults (AYAs) with HIV in Italy. Aims were to investigate the temporal trend of AYAs enrolment in the ICONA cohort over 2014-2023, and to compare their baseline characteristics and antiretroviral therapy (ART) outcomes with adults. All subjects enrolled in ICONA, the Italian cohort enrolling HIV-1 positive individuals from ART-naïve, over 2014-2023 were grouped into: AYAs (18-24 years old) and adults (≥25). Study outcomes were: time to first ART start, time to treatment discontinuation (TD) of first-line regimen, cause-specific TD, virologic failure, and loss-to-follow-up (LTFU). Overall, 9519 participants: 653 AYAs (6.9%) and 8,866 adults (93.1%). Excluding the decline recorded in 2020, the percentage of AYAs enrolled showed a similar trend before- and after-COVID. Compared with adults, AYAs had a milder clinical presentation, a better viro-immunological status, a higher mean change of cluster of differentiation 4 count over 24 months and, after adjusting, a higher risk of TD for patient's choice/adherence-related issues and LTFU. The less advanced clinical presentation and more robust immune recovery of AYAs, might depend upon more recent HIV infection, better thymic function, and lower immune activation. The higher risk of TD due to patient's choice/adherence-related issues and LTFU among AYAs is a major concern and suggests the need to create ad hoc clinical care pathways.