Search Results (154)

Background: Artificial intelligence (AI) is increasingly shaping the landscape of emergency surgery by offering real-time decision support, enhancing diagnostic accuracy, and optimizing workflows. However, its implementation raises significant ethical concerns, particularly regarding accountability, transparency, patient autonomy, and bias. Objective: This perspective paper, grounded in a narrative review, explores the ethical dilemmas associated with AI in emergency surgery and proposes future directions for its responsible and equitable integration. Methods: A comprehensive narrative review was conducted using PubMed, Scopus, Web of Science, and Google Scholar, covering the literature published from January 2010 to December 2024. We focused on peer-reviewed articles discussing AI in surgical or emergency care and highlighting ethical, legal, or regulatory issues. A thematic analysis was used to synthesize the main ethical challenges. Results: Key ethical concerns identified include issues of accountability in AI-assisted decision-making, the “black box” effect and bias in algorithmic design, data privacy and protection, and the lack of global regulatory coherence. Thematic domains were developed around autonomy, beneficence, justice, transparency, and informed consent. Conclusions: Responsible AI implementation in emergency surgery requires transparent and explainable models, diverse and representative datasets, robust consent frameworks, and clear guidelines for liability and oversight. Interdisciplinary collaboration is essential to align technological innovation with patient-centered and ethically sound clinical practice. Full article

Citruses are one of the major fruit crops globally. Among Mediterranean citrus producers, Sicily (southern Italy) is renowned for its high-quality fresh fruit production. Phytophthora diseases are a serious issue for citrus production worldwide and Phytophthora nicotianae is a prevalent causal agent of root rot in most citrus growing areas globally and particularly in the Mediterranean region. This study reports the occurrence of Phytophthora inundata as a root pathogen of declining mature citrus trees in eastern Sicily in association with P. nicotianae. This is the first record of P. inundata on citrus in Europe and the Mediterranean region. The species was identified on the basis of a morphology and multi-gene phylogenetic analysis, which included the internal transcribed spacer, β-tubulin and cytochrome c oxidase subunit 1. Pathogenicity tests on citrus saplings showed P. inundata was a less aggressive pathogen than P. nicotianae. However, the co-inoculation of both species produced more severe symptoms than inoculation with a single species, indicating an additive effect of these two pathogens and suggesting that opportunistic secondary pathogens like P. inundata may have a crucial role in complex diseases. Full article

Background: Extra virgin olive oil (EVOO), an essential element of the Mediterranean diet (MedDiet), has demonstrated considerable potential in improving mitochondrial health and protecting against chronic diseases. This narrative review aims to explore how the main phenolic compounds found in EVOO—hydroxytyrosol, oleuropein, and oleocanthal—contribute to mitochondrial health by reducing oxidative stress and inflammation. Methods: A search for scientific evidence was carried out between October 2024 and March 2025 in different bibliographic databases such as PubMed, Web of Science, Embase, SciSpace, and ResearchRabbit databases. The search strategy included combinations of terms such as “extra virgin olive oil”, “EVOO polyphenols”, “mitochondrial function”, “oxidative stress”, “inflammation”, “mitophagy”, and “chronic diseases”. Preclinical, clinical, and mechanistic studies were included, giving priority to peer-reviewed publications. Results: This narrative review shows how some bioactive components of EVOO activate cellular pathways, such as mTOR, AMPK and sirtuins, which promote mitochondrial biogenesis, improve the efficiency of the electron transport chain, and protect mitochondrial DNA integrity. Furthermore, EVOO improves mitochondrial membrane fluidity and integrity, ensuring its functionality and efficiency. On the other hand, nutrition literacy, an important component of health, is a critical determinant of people’s eating behaviors. Conclusions: Although recent scientific evidence supports the metabolic benefits of EVOO components on mitochondrial metabolism and function, further nutritional intervention studies with these components are recommended to confirm their clinical relevance as a dietary tool aimed at preventing and/or delaying age-related metabolic diseases. Full article

Introduction: Advanced magnetic resonance imaging (MRI) techniques in neuroplasticity evaluations provide important information on stroke disease and the underlying mechanisms of neuronal recovery. It has been observed that gray matter density or volume in brain regions closely related to motor function can be a valuable indicator of the response to treatment. Objective: To compare structural MRI-evaluated gray matter volume changes in patients with post-stroke upper limb spasticity for >1 year between those undergoing surgery and those treated with botulinum toxin A (BoNT-A) and to relate these findings to upper limb function and quality of life outcomes. Materials and Methods: Design. A two-arm controlled and randomized clinical trial in patients with post-stroke upper limb spasticity. Participants. Thirty post-stroke patients with spastic upper limbs. Intervention. Participants were randomly assigned (1:1 allocation ratio) for surgery (experimental group) or treatment with BoNT-A (control group). Main outcome measures. The functional parameters were analyzed with Fugl-Meyer, Zancolli, Keenan, House, Ashworth, pain visual analogue, and hospital anxiety and depression scales. Quality of life was evaluated using SF-36 and Newcastle stroke-specific quality of life scales. The carer burden questionnaire was also applied. Clinical examinations and MRI scans were performed at baseline and at six months post-intervention. Correlations between brain volume/thickness and predictors of interest were examined across evaluations and groups. Results: Five patients were excluded due to the presence of intracranial implants. Eleven patients were excluded from analyses since they were late dropouts. Changes were observed in the experimental group but not in the control group. Between baseline and six months, gray matter volume was augmented at the hippocampus and gyrus rectus and cortical thickness was increased at the frontal pole, occipital gyrus, and insular cortex, indicating anatomical changes in key areas related to motor and behavioral adaptation These changes were significantly related to subjective pain, Ashworth spasticity scale, and Newcastle quality of life scores, and marginally related to the carer burden score. Conclusions: The structural analysis of gray matter by MRI revealed differences in patients with post-stroke sequelae undergoing different therapies. Gray matter volume and cortical thickness measurements showed significant improvements in the surgery group but not in the BoNT-A group. Volume was increased in areas associated with motor and sensory functions, suggesting a neuroprotective or regenerative effect of upper limb surgery. Full article

Rectal cancer is a significant global health concern, particularly amongst the elderly population, with rectal cancer accounting for approximately one-third of cancer cases in this population. Older adults often present with advanced disease stages and unique clinical manifestations, such as tumors closer to the anal verge and with greater size. Diagnosis typically involves a series of screening and imaging strategies, culminating in accurate staging through pelvic MRI, endoscopic ultrasound, and CT scan. Management of rectal cancer in older adults emphasizes individualized treatment plans that consider both the cancer stage and the patient’s overall health status, including frailty and comorbidities. A multidisciplinary approach, including a mandatory geriatric assessment, is essential for optimizing outcomes, in order to improve survival and quality of life for elderly patients with rectal cancer. Full article

Subclinical carotid artery disease anticipates major cardiovascular events, and previous studies show that low vitamin D levels are associated with arterial stiffening in hypertension. The aim of the study was to examine the relationship of 25-hydroxyvitamin D [25(OH)D] levels with subclinical carotid disease in hypertensive patients. In 223 middle-aged, nondiabetic, primary hypertensive patients free of major cardiovascular and renal complications, we measured 25(OH)D and parathyroid hormone (PTH) and assessed subclinical carotid arteries changes by B-mode ultrasonography. The carotid intima-media thickness (IMT) and presence of plaques were assessed together with measurements of indexes of carotid artery distensibility (coefficient of distensibility) or stiffening (Young’s elastic modulus; β-stiffness). Lower 25(OH)D levels were associated with older age (p < 0.001), longer duration of hypertension (p = 0.019), higher fasting plasma glucose (p = 0.037), and insulin (p = 0.044), Homeostatic Model Assessment (HOMA) index (p = 0.044), and PTH (p < 0.001). Insufficient and deficient 25(OH)D were associated with progressively greater carotid IMT (p < 0.001), frequency of carotid plaques (p = 0.026), Young’s elastic modulus (p = 0.002), and β-stiffness (p < 0.001), and progressively lower carotid coefficient of distensibility (p < 0.001). Serum levels of 25(OH)D were negatively correlated with age (p < 0.001), duration of hypertension (p = 0.006), fasting glucose (p < 0.001), HOMA index (p = 0.032), PTH (p < 0.001), carotid IMT (p < 0.001), Young’s elastic modulus (p = 0.025), and β-stiffness (p < 0.001), and positively related with carotid coefficient of distensibility (p < 0.001). Multivariate regression analysis showed that both higher carotid IMT (p = 0.004) and lower coefficient of distensibility (p = 0.002) were related to lower 25(OH)D independent of age, severity, and duration of hypertension and metabolic variables. In conclusion, deficiency/insufficiency of 25(OH)D independently predicts subclinical carotid disease in uncomplicated, middle-aged, hypertensive patients and might predispose these patients to major cardiovascular complications. Full article

Background and Objectives: Leprosy primarily affects peripheral nerves, leading to significant neurological complications such as polyneuritis, mononeurosis, and autonomic dysfunction, which contribute to severe disabilities and impaired quality of life for patients. This scoping review aims to investigate the neurological manifestations and main treatments of leprosy patients. Materials and Methods: Studies were identified from an online search of PubMed, Web of Science, Cochrane Library, Embase, and Scopus databases. This review has been registered on OSF (n) PQBYH. Results: Neurological complications of leprosy, such as neuropathy and paralysis, necessitate accurate diagnosis and treatment, as immunological reactions can exacerbate nerve damage. Various studies highlight the effectiveness of personalized therapies, such as corticosteroids, multi-drug therapy (MDT), and surgical interventions, in improving symptoms and neurological function in leprosy patients. Conclusions: Managing neurological complications of leprosy necessitates careful diagnosis and treatment, as many patients experience unresolved peripheral neuropathy despite multidrug therapy. Future research should focus on improving diagnostic tools, exploring the link between neuropathic pain and psychological issues, and developing effective vaccines and treatments to enhance patient outcomes. Full article

Between October 2021 and July 2024, radon measurements in air and soil were carried out in the South and East flanks of Etna volcano to check the possible correlation between radon emissions and active faults/eruptive fissures and to obtain preliminary data on any negative impacts on human health. Fifteen continuous indoor radon monitors were installed in homes, some of which are inhabited by patients suffering from Multiple Sclerosis and Amyotrophic Lateral Sclerosis. In all sites, the limit of 300 Bq/m³ indicated by the Euratom Directive 2013/59 was exceeded, even if slightly and for short periods. The highest values were recorded closest to active fault zones and during winters. Furthermore, 27 discrete indoor radon measurements were carried out using a passive method by means of activated charcoal canisters that were exposed for 48 h. Most of the values (>70%) were <100 Bq/m³; six canisters gave values >100 Bq/m³ and one >200 Bq/m³. Measurements of radon in soils were carried out using a Durridge RAD7 in the gardens of the homes in which the indoor radon measurements were made. The background radon values in soils were <5000 Bq/m³; the highest values (12,500 Bq/m³) were measured near the Aci Catena fault. The role of Etna’s faults in draining the deeper radon towards the surface and, therefore, into nearby homes is evident, with a consequent increase in the health risk caused by indoor radon pollution. Full article

Soil erosion and the loss of soil organic carbon (SOC) pools are considered serious environmental problems in undulating landscapes on loess covers, accompanied in some areas, such as south Poland, by the physical degradation of chernozemic soils. The aim of the present study was to identify the scale and reasons for spatial variation of the SOC pools in the intensely cultivated Luvic Phaeozems in one of the unique patches of chernozemic soils in Poland. This study, carried out in a soil catena located in the undulating Carpathian Foreland in south-east Poland, has demonstrated that the SOC pools can greatly differ on a very small scale, even in relatively less differentiated landscapes and in soils classified into the same group. The scale and reasons for the differentiation of the SOC pools depend on the method (depth) of calculation. The spatial differences were smaller and were mainly related to the SOC concentrations and the bulk density of the topsoil horizons, when calculated for depths of 0–30 cm and 0–50 cm. On the other hand, the SOC pools calculated for the 0–100 cm soil layer differed most significantly between the profiles in the catena, representing a continuous growing trend from the uppermost towards the lowermost part of the catena, and were clearly related to the total thickness of the humus horizon(s). The latter findings confirm that sheet erosion has a major impact on the spatial variation of SOC pools in an agricultural landscape. However, soil morphology and the distribution of SOC across the soil profiles suggest additional influences from historical pedogenesis and modern farming technology. The presence of black, thick and humus-rich chernic horizons in all soils across the catena indicates that modern farming must not degrade the soils, but, on the contrary, it can help in the restoration of even neo-formation of chernozemic soils (Phaeozems), if oriented towards the conservation of humus content, soil structure, and biological activity. Full article

Metal–organic framework materials, as innovative functional materials for nonlinear optical technologies, feature linear and nonlinear optical responses, such as a laser damage threshold, outstanding mechanical properties, thermal stability, and optical transparency. Their non-centrosymmetric crystal structure induces a higher-order nonlinear optical response, which guarantees technological applications. Zn^II– and Ag^I–squarate complexes are attractive templates for these purposes due to their good crystal growth, optical transparency, high thermal stability, etc. However, the space group type of the catena-((μ₂-squarato)-tetra-aqua-zinc(II)) complex ([Zn(C₄O₄)(H₂O)₄]) is debatable, (1) showing centro- and non-centrosymmetric monoclinic C2/c and Cc phases. The same is valid for the catena-((μ₃-squarato)-(μ₂-aqua)-silver(I)) complex (Ag₂C₄O₄), (2) exhibiting, so far, only a C2/c phase. This study is the first to report new crystallographic data on (1) and (2) re-determined at different temperatures (293(2) and 300(2)K) and the non-centrosymmetric Cc phase of (2), having different numbers of molecules per unit cell compared with the C2/c phase. There are high-resolution crystallographic measurements of single crystals, experimental electronic absorption, and vibrational spectroscopic data, together with ultra-high-resolution mass spectrometric ones. The experimental results are supported for theoretical optical and nonlinear optical properties obtained via high-accuracy static computational methods and molecular dynamics, using density functional theory as well as chemometrics. Full article

Background: The acute hemodynamic response to isometric exercise in hypertensive patients’ ischemic heart disease (IHD) has been poorly investigated. The aim of this study was to assess acute changes in left ventricular myocardial work (MW) during isometric bilateral knee extension in patients with IHD. Methods: Twenty stable hypertensive patients with IHD and ten healthy, age-matched controls (HC) were enrolled. All subjects performed an isometric knee extension exercise at 30% of their maximal voluntary contraction. The effort was maintained for three minutes or until exhaustion. At baseline, at peak exercise, and after 10 min of recovery, echocardiography evaluation was performed and blood pressure (BP) and heart rate (HR) were measured. Results: The exercise was well tolerated by all subjects. At peak exercise, systolic BP in the IHD was significantly higher than HC (37.6 ± 7.2 vs. 8.4 ± 2.3 mmHg; p 0.002). The HC group had a greater increase in HR than IHD (19.7 ± 6.2 vs. 8.4 ± 2.2 bpm; p 0.009). The E/E′ ratio increased in IHD and was unchanged in the control group. The global work index increased significantly in IHD compared to HC (+15% vs. +3%; p 0.026). Global constructive work increased significantly in IHD compared to HC (+29.8% vs. +7.4 respectively, p 0.031). Global wasted work increased by 92.3% in IHD and was unchanged in HC. The global work efficiency decreased in IHD (−18%), but was unchanged in HC (between-groups p 0.019). Stroke volume decreased in IHD and was unchanged in HC. Cardiac output was unchanged in IHD, while it increased in HC. Conclusion: In patients with hypertension and underlying IHD, an acute isometric load causes a great increase in systolic BP and LV filling pressure. It follows a mostly ineffective increase in MW that fails to maintain stroke volume. Full article

Neoplastic plasma cells (PCs) proliferation at anatomic sites dislocated from the bone marrow (BM) or their contiguous growth from osseous lesions that disrupt the cortical bone is termed extramedullary multiple myeloma (EMD). EMD still remains challenging from a therapeutic and biological perspective. Pathogenesis has not been completely clarified, and it is generally associated with high-risk cytogenetics (HRCAs). In order to emphasize the clinical and biochemical complexity of this disease, we have decided to describe the case of a patient affected by relapsed-refractory (RR) EMD, which presented as para-osseous plasmacytoma with a bi-phenotypical immunoglobulin (Ig) component and lately relapsed as soft-tissue plasmacytoma with a total immunophenotype switch. We have also hypothesized a correlation between Ig patterns and prognosis and suggested the possible inclusion of these biochemical features in the general risk assessment. Full article

Intra-abdominal infections (IAIs) account for a major cause of morbidity and mortality, representing the second most common sepsis-related death with a hospital mortality of 23–38%. Prompt identification of sepsis source, appropriate resuscitation, and early treatment with the shortest delay possible are the cornerstones of management of IAIs and are associated with a more favorable clinical outcome. The aim of source control is to reduce microbial load by removing the infection source and it is achievable by using a wide range of procedures, such as definitive surgical removal of anatomic infectious foci, percutaneous drainage and toilette of infected collections, decompression, and debridement of infected and necrotic tissue or device removal, providing for the restoration of anatomy and function. Damage control surgery may be an option in selected septic patients. Intra-abdominal infections can be classified as uncomplicated or complicated causing localized or diffuse peritonitis. Early clinical evaluation is mandatory in order to optimize diagnostic testing and establish a therapeutic plan. Prognostic scores could serve as helpful tools in medical settings for evaluating both the seriousness and future outlook of a condition. The patient’s conditions and the potential progression of the disease determine when to initiate source control. Patients can be classified into three groups based on disease severity, the origin of infection, and the patient’s overall physical health, as well as any existing comorbidities. In recent decades, antibiotic resistance has become a global health threat caused by inappropriate antibiotic regimens, inadequate control measures, and infection prevention. The sepsis prevention and infection control protocols combined with optimizing antibiotic administration are crucial to improve outcome and should be encouraged in surgical departments. Antibiotic and antifungal regimens in patients with IAIs should be based on the resistance epidemiology, clinical conditions, and risk for multidrug resistance (MDR) and Candida spp. infections. Several challenges still exist regarding the effectiveness, timing, and patient stratification, as well as the procedures for source control. Antibiotic choice, optimal dosing, and duration of therapy are essential to achieve the best treatment. Promoting standard of care in the management of IAIs improves clinical outcomes worldwide. Further trials and stronger evidence are required to achieve optimal management with the least morbidity in the clinical care of critically ill patients with intra-abdominal sepsis. Full article

Accuracy in the evaluation of death-induced tissue degradation for thanato-chronological purposes is strictly dependent on the condition of the biological source as well as on the precision of post-mortem interval (PMI) estimation. Thus, the optimization of tissue handling and identification of sensitive post-mortem biomarkers could help establish a timeline for post-mortem events. To this aim, we investigated the proteome changes in cortex samples of 6-week-old female SAMR1 mice over a post-mortem time course. After death, brain tissue was removed immediately (T0), and after 4, 8, 12, 24, and 32 h, four mice were used for each time period, and animals were maintained at 4 °C until brain removal. Dissected tissues were frozen at −80 °C until processed. Proteomic analysis, performed on samples related to early and late PMIs (<24 h and >24 h post-mortem, respectively) showed protein level changes as compared to T0 samples, with a remarkable increase in Calpain11 in the early PMI, as well as in Caspases 7 and 8 together with Gasdermin 3 in late PMI. These findings were confirmed by LIFT mass spectrometry technology and western blot analysis and, although requiring further investigation in other biological samples, suggest that these proteins could be considered as putative biomarkers of different PMIs. Full article