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Abstract BackgroundThe ADNEX model (Assessment of Different NEoplasias in the adnexa) is the best performing model to predict the risk of malignancy (binary) and type of malignancy (multiclass) in ovarian tumors. The immune system plays a role in the onset and progression of ovarian cancer. Preliminary research has suggested that immune-related biomarkers can help in the discrimination of ovarian tumors. We aimed to assess which proteins have the most additional diagnostic value in addition to ADNEX’ clinical and ultrasound predictors.Materials and methodsIn this exploratory diagnostic study, 1086 patients with an adnexal mass scheduled for surgery were consecutively enrolled at five oncology centers and one non- oncology center in Belgium, Italy, Czech Republic and United Kingdom between 2015 and 2019. The quantification of 33 serum proteins was carried out preoperatively, using multiplex high throughput immunoassays (Luminex) and electrochemiluminescence immuno-assay (ECLIA). Logistic regression analysis was performed for ADNEX’ clinical and ultrasound predictors alone (age, maximum diameter of lesion, proportion of solid tissue, presence of >10 cyst locules, number of papillary projections, acoustic shadows and ascites) and after adding proteins. We reported the AUC for benign vs malignant, Polytomous Discrimination Index (PDI; a multiclass AUC) and pairwise AUCs for pairs of tumor types. AUCs were corrected for optimism using bootstrapping.ResultsAfter applying exclusion criteria, 932/1086 patients were eligible for analysis (474 benign, 135 borderline, 84 stage I primary invasive cancer, 208 stage II-IV primary invasive cancer, 31 secondary metastatic invasive tumors). ADNEX predictors alone had an AUC of 0.909 (95% CI 0.894-0.929) to discriminate benign from malignant tumors, and a PDI of 0.532 (0.510-0.589). HE4 yielded the highest increase in AUC (+0.026), followed by CA125 (+0.017). CA125 yielded the highest increase in PDI (+0.049), followed by HE4 (+0.036). Whereas CA125 mainly improved pairwise AUCs between different types of invasive tumors (increases between 0.020-0.165 over ADNEX alone), HE4 mainly improved pairwise AUCs for benign tumors versus stage I (+0.022) and benign tumors versus stage II-IV ovarian cancers (+0.028). CA72.4 might be useful to distinguishing secondary metastatic tumors from benign, borderline, and stage I tumors. CA15.3 might be useful to discriminate borderline tumors from stage I and stage II-IV tumors. Distinguishing stage I and borderline tumors (AUCs ≤ 0.72) and stage I and secondary metastatic tumors (AUCs ≤ 0.76) remained difficult after adding proteins.ConclusionsCA125 had the highest added value over clinical and ultrasound predictors to distinguish between the five tumor types, followed by HE4. In addition, CA72.4 and CA15.3 may further improve discrimination but findings for these proteins should be confirmed. The immune-related proteins were in general not able to discriminate the groups.

Norovirus (NoV) is recognised as a major cause of epidemic and sporadic acute gastroenteritis (AGE) in all age groups. Information on the genetic diversity of the NoVs circulating in the 1980s and 1990s, before the development and adoption of dedicated molecular assays, is limited compared to the last decades. In the period 1986-2020, uninterrupted viral surveillance was conducted in symptomatic children hospitalized for AGE in Palermo, Italy, providing a unique time capsule for exploring the epidemiological and evolutionary dynamics of enteric viruses. In this 35-year long time span NoVs of genogroup II (GII) were detected in 15.6% of AGE requiring hospitalization, whilst GI NoVs in 1.4%. Overall, the predominant NoV capsid (Cap) genotype was GII.4 (60.8%), with temporal replacement of the GII.4 Cap variants and associated polymerase (Pol) types. The chronology of emergence and circulation of the different GII.4 variants were consistent with the data available in literature. Also, for GII.3 and GII.2 NoVs the circulation of different lineages/strains, differing in either the Cap or Pol genes or in both, was observed. This long-term study revealed the ability of NoVs to modify continuously and rapidly their genomic makeup and highlights the importance of surveillance activities for vaccine design.

Background: Extraventricular neurocytoma (EVN) is an extremely rare neoplasm of the central nervous system. As reported, it arises in a variety of locations, but mainly within the cerebral hemispheres. Despite its histological similarity with central neurocytoma (CN), EVN occurs outside the ventricular system and, in 2007, was recognized by the World Health Organization as a separate entity.Case Description: A 39-year-old man, with a ventriculoperitoneal shunt inserted for communicating hydrocephalus, was admitted at our Unit of Neurosurgery with a 1-month history of gait disturbance, postural instability, speech disorders, and occasional incontinence. Computed tomography scan and magnetic resonance imaging showed a mixed-density neoplasm in the left frontotemporal area, with anterior cerebral falx shift, and perilesional edema. The patient underwent surgical procedure; microsurgical excision of the lesion was performed through left pterional approach. Histopathological and immunohistochemical examination revealed monomorphic round cells of the neuronal lineage, with a percentage of Ki-67 positive nuclei <5% and no evidence of mitosis or necrotic areas. According to radiologic features, this pattern was compatible with the diagnosis of EVN. Patient had a favorable recovery and he is still in follow-up.Conclusion: Because of their rarity, clinical, radiologic, and histopathological characteristics of EVNs are not yet well defined, as well as the optimal therapeutic management. Whereas EVNs are rarely described in literature, we aimed to share and discuss our experience along with a review of the published literature.

Several researchers have analyzed the collocation of infraorbital foramen, but no study has so far considered the possible influence of cranial size.Three measurements (distances from anterior nasal spine, inferior orbital rim, angle at the intersection between the line from anterior nasal spine and the transversal plane parallel to the Frankfurt plane) were taken on 100 skulls belonging to a contemporary skeletal collection. In addition, maximum cranial length, maximum cranial breadth, cranial height, and bizygomatic breadth were measured, together with 2 indices (horizontal cephalic index and Giardina Y-index). Differences according to sex and side were assessed through 2-way analysis of variance test (P <0.05). Measurements showing statistically significant differences according to sex were further assessed through 1-way analysis of covariance test including cranial measurements and indices as covariates (P <0.05).Statistically significant differences according to sex and side were found respectively for the distance from anterior nasal spine and the angle at infraorbital foramen (P <0.05). One-way analysis of covariance test verified that the sexual dimorphism of infraorbital foramen- anterior nasal spine distance was independent from the general measurements of cranium.The present study first proved that sexually dimorphic parameters useful for the localization of infraorbital foramen do not depend upon the cranium size.

Introduction: The sinactive developmental model provides suggests a different way for the brain study by observing the children behavior. In all neurodevelopmental disorders, we can observe autonomic alteration comprising sleep disorders, meal behaviour alteration and self-regulatory impairment. These alterations/impairment are very frequent in autism spectrum disorders (ASD) (1-12). Aim of the present preliminary study is the assessment of metabolic rate in children affected by ASD. Material s and methods. 5 males affected by ASD aged 7-10 years (mean age 6.73±3:39), were recruited. The average score at the ADOS scale was 12.24 (SD± 3.29). The control group consisted of 5 males typically developing children (TDC) aged 7 to 11 years (mean age 7.92 ± 3.23). Autonomic/Metabolic evaluation: Free-living daily physical activity was measured using either the SenseWear Armband in order to calculate the total energy expenditure (TEE), baseline (REE) and the metabolic physical activity for prolonged periods of time. In general, the SenseWear Armband allows objective monitoring of the lifestyle including duration and sleep efficiency. Results: ASD subjects show values of total energy expenditure (p = 0.0047) and active energy expenditure (p = 0.044) significantly higher compared to control subjects (Table 1). In addition, ASD children have a metabolic intermediate significantly higher than healthy subjects (p=0.015). (Table 1). Finally, the ASD children show a significant reduction of sleep time (p = 0.027) (Table 1). Conclusion: ASD can represents a very significant risk factor for developing sleep disorders and to high energy expenditure, although further studies are needed in this respect.

The transformation of furfural into functionalized cyclopentenone derivatives is a smart process to advance the sustainable synthesis of important chemicals from biomass.

to develop and validate a predictive model of mortality or emergency hospitalization in all subjects aged 65 years and over. cohort study based on 9 different databases linked with each other. the model was developed on the population aged 65 years and over resident at 01.01.2011 for at least two years in the city of Bologna (Emilia-Romagna Region, Northern Italy); 96,000 persons were included. the outcome was defined in case of emergency hospitalization or death during the one-year follow-up and studied with a logistic regression model. The predictive ability of the model was evaluated by using the area under the Roc curve, the Hosmer-Lemeshow test, and the Brier score in the derivation sample (2/3 of the population). These tests were repeated in the validation sample (1/3 of the population) and in the population of Bologna aged 65 years and over on 01.01.2012, after applying the coefficients of the variables obtained in the derivation model. By using the regression coefficients, a frailty index (risk score) was calculated for each subject later categorized in risk classes. the model is composed of 28 variables and has good predictive abilities. The area under the Roc curve of the derivation sample is 0.77, the Hosmer-Lemeshow test is not significant, and the Brier score is 0.11. Similar performances are obtained in the other two samples. With increasing risk class, the mean age, number of hospitalizations, emergency room service consultations, and multiple drug prescriptions increase, while the average income decreases. the model has good predictive ability. The frailty index can be used to support a proactive medicine and stratify the population, plan clinical and preventive activities or identify the potential beneficiaries of specific health promotion projects.

Introduction: ADHD is characterized by inattention, hyperactivity, impulsivity, or a combination of these symptoms. Sleep disorders may be considered as a not secondary underlying cause of ADHD and growing evidence evidenced that obstructive sleep apnea syndrome (OSA) symptoms may overlap ADHD's ones. Aim of the present study is verifying the presence of ADHD-like symptoms in other frequent condition such as sleep-related breathing disorders in pediatric age. Materials and methods: 34 children (19 males and 15 females) aged 6-10 years (mean age 9.706 ± 3.434) with polysomnographic diagnosis of OSA, according to ICSD-3 criteria, were recruited. Control group was composed by 89 typical developing children (47 males, 42 females) (mean age 9,528 ± 3,351). The Conners' Rating Scale- Revised (CRS-R) test was administered to mothers to assess their children's behavior. Results: The two groups are comparable for age (p = 0.794) and sex distribution (p = 0.918). Subjects affected by OSA present higher scores in pathological range in all scales of CRS-R than controls (Table 1). Conclusions: Scientific and clinical evidences tend to stress the similarities between ADHD and OSA effects/comorbidities in pediatric age, suggesting sleep screening as mandatory before starting stimulant drugs treatment.

Autism spectrum disorder (ASD) is a complex neurodevelopmental syndrome of emerging public health concern, according to a documented significant increase of diagnosed cases of ASD in Europe and USA. In Italy, actually, it is not possible to estimate at national level a reliable ASD occurrence by using existing health and scholastic data flows. The lack of information has implications on social and healthcare services dedicated to subjects affected by ADS. The database of the Italian institute in charge of social and security assistance was accessed at the provincial level to investigate the ASD cases occurred in the Palermo province. The official reports of all subjects visited in 2013 by INPS physicians were analyzed by using an automatic software and diagnosis consistent with ASD were extracted and flagged. Our findings support the choice of alternative use of INPS administrative database in order to define a reliable ASD occurrence estimate as first step to develop an integrated epidemiological surveillance system on ASD.