Search Results (766)

Heart failure and diabetes mellitus are major contributors to global morbidity and mortality, with their prevalence continuously rising, primarily due to aging populations and improvements in healthcare. These conditions often coexist or develop sequentially, leading to complex interactions that significantly influence the progression and management of both diseases. Furthermore, heart failure and diabetes are commonly associated with coronary artery disease, which presents a unique challenge in clinical management, particularly in the context of myocardial revascularization. The presence of diabetes exacerbates atherosclerotic progression and impairs endothelial function, while heart failure complicates the perfusion and recovery of myocardial tissue post-intervention. This narrative review delves into the underlying mechanisms contributing to revascularization failure in patients with heart failure and diabetes, emphasizing the importance of understanding these interactions for optimal treatment. The review also summarizes key findings from randomized controlled trials, examining evidence both in the general population and in specific subgroups, including the elderly and patients with left main coronary artery disease, chronic kidney disease, peripheral artery disease, and chronic obstructive pulmonary disease. Understanding these complexities is critical for improving patient outcomes. Full article

This paper examines multisensory museums, envisioned as extended or hybrid realities where the physical and digital coexist to offer cognitively and emotionally engaging experiences to the public, while enhancing the sense of authenticity. Multisensory communication can improve accessibility, as it conveys the content through multiple perceptual channels, and it can solicit more inclusive, participatory, and creative audience engagement through the stimulation of emotions. A methodological approach to digitisation, communication strategies, interaction, creative storytelling, immersive technologies, and accessibility issues are discussed in depth, in relation to emerging museological practices. Machine learning and generative AI are opening new scenarios in management practices and decision-making, in data analyses and in natural language processing, and in the creation of personalised content addressed to the audience. A short overview about how these algorithms evolve and work is presented, considering the challenges, threats, expectations, and ethical implications they pose. Another key topic is the sense of authenticity. How is it changing in today’s users? How do virtual and mixed realities, storytelling, and user experience design in museums influence it? This paper explores these issues, presenting some case studies which have cultural, social, philosophical, and ethical implications, at a time when museums are redesigning their role in a society undergoing profound transformation. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a public health concern, linked with immune-metabolic dysfunction. While lifestyle and dietary modifications remain the cornerstone of MASLD management, the optimal dietary approach remains uncertain. Objectives: This systematic review aims to investigate the impact of model dietary patterns on metabolic outcomes in patients with MASLD and evaluate their effects in individuals with coexisting metabolic conditions, such as obesity, metabolic syndrome, and type 2 diabetes mellitus (T2DM). Methods: To conduct the review, PubMed, Scopus, Google Scholar, Cochrane CENTRAL, and ClinicalTrials.gov databases were searched for Randomized Controlled Trials (RCTs) on the adult population, published between January 2019 and September 2024, following PRISMA principles. The quality of the included RCTs was assessed qualitatively based on study characteristics. Results: The main findings of this review demonstrated that the use of interventions with dietary model based on Mediterranean diet (MED) and intermittent fasting (IF) approaches, such as alternative-day fasting (ADF) and time-restricted feeding regimens (TRF) may have potential in reducing body weight, BMI, and waist circumference, with additional benefits of improving glycemic control and reducing inflammation. The effects on hepatic functions, although limited, may be linked with reduced enzyme activity and liver stiffness. Additionally, the use of lacto-ovo-vegetarian diet (LOV-D) and the Dietary Approaches to Stop Hypertension (DASH) diet may offer additional health benefits, including blood pressure management. Conclusions: This review suggests that MED and IF-based strategies may reduce BW, improve glycemic control, and lower inflammation, with potential benefits for hepatic function. Further long-term studies are needed to confirm these effects and underlying mechanisms, which will allow for the optimization of protocols and ensure their safety in MASLD. Full article

Background: Lipedema is a chronic disorder characterized by disproportionate fat accumulation in the extremities, predominantly affecting women. Unlike obesity, lipedema might be associated with a lower prevalence of metabolic alterations despite often coexisting with overweight or obesity. Fat distribution plays a crucial role in metabolic differences, with gynoid fat in lipedema being associated with a lower risk of insulin resistance and cardiovascular disease. The present study aims to compare biochemical parameters between women with lipedema and those with lifestyle-induced overweight/obesity. Methods: This study involved 108 women, including 53 with lipedema and 55 with lifestyle-induced overweight/obesity. Anthropometric measurements and body composition analyses were conducted, and biochemical parameters related to liver function, lipid profile, kidney and thyroid function, uric acid levels, and carbohydrate metabolism were assessed. Statistical comparisons were made between groups, and multivariate models were used to explore the relationships between disease type, metabolic parameters, and body composition. Results: Women with lipedema exhibited a more favorable metabolic profile than those with overweight/obesity. Dyslipidemia was observed in ~50% of the lipedema group, compared to nearly 70% in the overweight/obesity group. Impaired glucose metabolism and insulin resistance were significantly less prevalent in the lipedema group (18.9% vs. 43.6%, p < 0.05). Conclusions: Despite having a high BMI, women with lipedema demonstrate fewer metabolic alterations than those with overweight/obesity. Fat distribution, rather than overall adiposity, appears to influence metabolic risk. These findings highlight the need for targeted therapeutic approaches to lipedema, distinct from conventional obesity management strategies. Full article

Aethina tumida, commonly known as the small hive beetle, poses a threat to honeybee populations, particularly Apis mellifera, across several European regions. Originating in sub-Saharan Africa, there is a risk of the infestation spreading from Calabria, a region in the south of Italy. The essential role played by Apis spp. in pollination biodiversity preservation, agricultural productivity, and the overall economy is related to the dangers posed by the invasion of Aethina tumida. Current detection methods often fail to identify infestations early, leading to significant colony losses. We focused on creating a biosensor to improve the detection of Kodamaea ohmeri, a recently identified yeast that coexists symbiotically with Aethina tumida. The biosensor was designed to exploit the highly sensitive quartz crystal microbalance to identify a specific peptide linked to Kodamaea ohmeri in honey specimens. Its gold-plated surface over quartz was functionalized with an antibody effective in recognizing the peptide associated with Kodamaea ohmeri, a potential warning for detecting Aethina tumida. Preliminary results support the possibility of using such biosensor technology to detect infestation and enhance colony management techniques for honeybees, enabling beekeepers to implement prompt and focused treatments. In addition, reducing the size and cost of these biosensors and offering user training would be very helpful in having them used in beekeeping. Full article

Flood models based on high-resolution digital elevation models (DEMs) are important for identifying urban land inundation during extreme rainfall events. Urban pluvial and fluvial floods are influenced by distinct processes that are interconnected; thus, they can transform into one another. Conventional flood models struggle to delineate inundation caused by drainage system overflow (urban pluvial flood) and that caused by rivers (urban fluvial flood). In this study, we proposed a novel method for identifying urban pluvial–fluvial floods using a high-resolution DEM. We developed a DEM-based surface pluvial and fluvial inundation tracking model (DEM-SPFITM) that incorporated flood development and mutual transformation processes. When combined with a surface flood control model (SFCM), this approach enabled tracking of the flow paths and exchanged water volume associated with both flood types. The case study results indicate that the proposed method effectively captures the interplay between pluvial and fluvial flooding, enabling the separate identification of flood extent, depth, and velocity under extreme rainfall conditions for both pluvial and fluvial flooding. Compared to the conventional approach, which independently simulates pluvial and fluvial flooding using the SFCM and subsequently overlays the results to estimate pluvial–fluvial flooding inundation, the proposed method demonstrates superior accuracy and computational efficiency. Simulations of three extreme rainstorms indicated that pluvial flooding primarily contributed to extensive land inundation, characterised by shallower depths and lower velocities, with a limited influence of flood depth on velocity. Meanwhile, fluvial flooding further exacerbated land inundation, leading to significant pluvial–fluvial coexistence. In areas adjacent to these flood zones, fluvial flooding predominated, resulting in greater inundation depths and a more pronounced effect of flood depth on velocity. As rainfall intensity and total rainfall increased, the area of fluvial inundation diminished significantly, whereas pluvial–fluvial coexistence intensified and was distributed in zones with relatively large inundation depths and higher flow velocities. This research presented a novel method for distinguishing between urban pluvial–fluvial floods, providing valuable insights for integrated urban flood management and joint flood risk zoning. Full article

With the continuous advancement of Mobility as a Service (MaaS), a hybrid traffic flow comprising MaaS-based and conventional trips has emerged within transportation networks, leading to diverse behaviors among heterogeneous travelers. Given the coexistence of heterogeneous travelers during the promotion of MaaS, this paper investigates two distinct groups: travelers using MaaS subscription services (defined as “subscribed users”) and traditional travelers who rely on personal experience (defined as “decentralized users”). Accordingly, we propose a day-to-day and within-day bi-level dynamic traffic assignment model for heterogeneous travelers under the MaaS framework. By optimizing subscribed users’ travel decisions, this model assists urban planners in predicting the evolution of mixed traffic flows, enabling improved road resource allocation and subscription service mechanisms. For the day-to-day component, the model explicitly incorporates mode-switching behaviors among heterogeneous travelers. In the within-day context, departure time and route choices are considered, along with travel time costs and additional costs arising from early or late arrivals. Consequently, we propose a within-day, time-dependent traffic assignment model specifically tailored for heterogeneous users. For modeling subscribed users’ traffic assignment, we develop a system-optimal (SO) bi-level programming model aiming at minimizing the total travel cost. Furthermore, by integrating an improved Genetic Algorithm with the Method of Successive Averages (MSA), we introduce an enhanced IGA-MSA hybrid algorithm to solve the proposed model. Finally, numerical experiments based on the Nguyen–Dupuis network are conducted to evaluate the performance of the proposed model and algorithm. The results indicate that the network with heterogeneous MaaS users can reach a steady state effectively, significantly reducing overall travel costs. Notably, decentralized users rapidly shift towards becoming subscribed users, highlighting the attractiveness of MaaS platforms in terms of cost reduction and enhanced travel experience. Additionally, the IGA-MSA hybrid algorithm effectively decreases overall travel costs in the early evolution stages and achieves a more balanced temporal distribution of trips across the system, effectively managing congestion during peak periods. Full article

Aortic stenosis (AS) frequently coexists with coronary artery disease (CAD), complicating revascularization decisions. The use of coronary physiology indices, such as the fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), and coronary flow reserve (CFR), in AS patients remains debated, particularly after transcatheter aortic valve implantation (TAVI). In this study, we employ computational fluid dynamics (CFD) to evaluate coronary hemodynamics and assess changes in the wall shear stress (WSS) before and after TAVI. Our analysis demonstrates strong agreement between CFD-derived and invasive FFR measurements, confirming CFD’s reliability as a non-invasive tool for coronary physiology assessment. Furthermore, our results show no significant changes in FFR ($p=0.92$), iFR ($p=0.67$), or CFR ($p=0.34$) post-TAVI, suggesting that these indices remain stable following aortic valve intervention. However, a significant reduction in high WSS exposure (59% to 40.8%, $p<0.001$) and the oscillatory shear index (OSI: 0.32 to 0.21, $p<0.001$) was observed, indicating improved hemodynamic stability. These findings suggest that coronary physiology indices remain reliable for revascularization guidance post-TAVI and highlight a potential beneficial effect of aortic stenosis treatment on plaque shear stress dynamics. Our study underscores the clinical utility of CFD modeling in CAD management, paving the way for further research into its prognostic implications. Full article

Autism spectrum disorder (ASD) is a group of complex neurodevelopmental conditions with a heterogeneous and multifactorial etiology that is not yet fully understood. Among the various factors that may contribute to ASD development, alterations in the gut microbiota have been increasingly recognized. Microorganisms in the gastrointestinal tract play a crucial role in the gut–brain axis (GBA), affecting nervous system development and behavior. Dysbiosis, or an imbalance in the microbiota, has been linked to both behavioral and gastrointestinal (GI) symptoms in individuals with ASD. The microbiota interacts with the central nervous system through mechanisms such as the production of short-chain fatty acids (SCFAs), the regulation of neurotransmitters, and immune system modulation. Alterations in its composition, including reduced diversity or an overabundance of specific bacterial taxa, have been associated with the severity of ASD symptoms. Dietary modifications, such as gluten-free or antioxidant-rich diets, have shown potential for improving gut health and alleviating behavioral symptoms. Probiotics, with their anti-inflammatory properties, may support neural health and reduce neuroinflammation. Fecal microbiota transplantation (FMT) is being considered, particularly for individuals with persistent GI symptoms. It has shown promising outcomes in enhancing microbial diversity and mitigating GI and behavioral symptoms. However, its limitations should be considered, as discussed in this narrative review. Further research is essential to better understand the long-term effects and safety of these therapies. Emphasizing the importance of patient stratification and phenotype characterization is crucial for developing personalized treatment strategies that account for individual microbiota profiles, genetic predispositions, and coexisting conditions. This approach could lead to more effective interventions for individuals with ASD. Recent findings suggest that gut microbiota may play a key role in innovative therapeutic approaches to ASD management. Full article

Background: Mixed neuroendocrine–non-neuroendocrine tumors (MINEN) of the liver are exceptionally rare, with limited data available regarding their clinical behavior, pathogenesis, and optimal management. The coexistence of hepatocellular carcinoma (HCC) and neuroendocrine carcinoma (NEC) within the liver presents diagnostic and therapeutic challenges. Methods: A systematic literature search was conducted on PubMed, identifying cases of primary mixed HCC and NEC in the liver. The search adhered to PRISMA guidelines, and relevant studies were critically analyzed. A total of 45 documented cases were reviewed, focusing on patient demographics, clinical characteristics, treatment strategies, and outcomes. Results: Most patients (90%) were male, with a median age of 66.5 years. Hepatitis B or C infection was present in 74% of cases, and liver cirrhosis was reported in 38%. The combined type was the most frequently observed histological pattern (65%). Treatment modalities varied, including transarterial chemoembolization (TACE), radiofrequency ablation (RFA), surgery, and systemic therapies. The median overall survival was 10 months, highlighting the aggressive nature of these tumors. Conclusions: Given the rarity and poor prognosis of hepatic MINEN tumors, multidisciplinary management is essential. Advanced molecular profiling may offer insights into tumor biology and potential therapeutic targets. Future research should explore novel systemic therapies, including immune checkpoint inhibitors, to improve patient outcomes. Full article

Fabry disease (FD) is a rare X-linked lysosomal storage disorder caused by mutations in the GLA gene, leading to α-galactosidase A deficiency and subsequent accumulation of glycosphingolipids, including globotriaosylceramide (Gb3) and globotriaosylsphingosine (lyso-Gb3), in multiple organs. This accumulation can result in multisystemic disease and life-threatening complications. FD presents with a broad phenotypic spectrum, ranging from the classic form, with early and severe symptoms, to a later-onset form with variable manifestations. The severity of the disease in females is more variable due to X-chromosome inactivation (XCI). Renal involvement is a key feature, and kidney biopsy remains a valuable tool for diagnosing FD and assessing the extent of nephropathy. Although molecular genetic testing is the gold standard for diagnosis, kidney biopsy aids in confirming renal involvement, detecting coexisting conditions, and determining the pathogenicity of variants of uncertain significance (VUSs). Moreover, kidney biopsy can serve as a prognostic tool by identifying early markers of nephropathy, such as foot process effacement and glomerular sclerosis, which predict disease progression. Emerging technologies, including machine learning, offer the potential to enhance the analysis of renal histology, improving diagnostic accuracy and patient stratification. Despite the challenges posed by overlapping diseases and potential misdiagnoses, kidney biopsy remains an essential component of FD diagnosis and management, facilitating early detection, the monitoring of disease progression, and the evaluation of therapeutic responses. Full article

Acute and recurrent pustulosis (ARP), previously known as actinic folliculitis, superficial actinic folliculitis, or even acne aestivalis, is a rare, underdiagnosed dermatological condition characterized by the sudden onset of monomorphic pustular eruptions on an erythematous background localized predominantly on the upper body. While typically associated with sun exposure, ARP can also be triggered by other factors, such as heat or sweating, underscoring its multifactorial etiology. We report the case of a 40-year-old woman with ARP, presenting diagnostic challenges due to overlapping clinical features and the coexistence of atopic dermatitis (AD), an association not previously documented in the literature. The patient exhibited recurrent pustular episodes localized on sun-exposed and non-exposed areas, unresponsive to conventional therapies. Comprehensive microbiological, histopathological, and clinical assessments excluded infectious, drug-induced, and other inflammatory pustular dermatoses, confirming the diagnosis of ARP. Importantly, treatment with Baricitinib, a Janus kinase (JAK) inhibitor primarily prescribed for AD, resulted in marked improvement in both conditions, suggesting shared inflammatory pathways. This therapeutic response highlights the potential role of JAK inhibitors in ARP management, particularly in cases resistant to standard interventions. This report also proposes the inclusion of heat- and sweat-induced ARP as a distinct subtype, expanding the understanding of its diverse triggers beyond UV radiation. Furthermore, it underscores the need for standardized diagnostic criteria and a structured approach to differential diagnosis, given the condition’s underdiagnosed and often misinterpreted nature. By shedding light on the clinical and therapeutic aspects of ARP, this case contributes to a more nuanced understanding of this rare entity and its potential interplay with inflammatory skin disorders such as AD. Full article

Conflicts between humans and Japanese macaques (Macaca fuscata) have intensified due to urban and agricultural expansion, reducing natural habitats and pushing macaques into human settlements. This review examines strategies for managing human–macaque coexistence in Japan. Since the 1970s, urbanisation and deforestation have led to increased macaque migration into populated areas, resulting in property damage, crop loss, and, in some cases, aggressive encounters. The growing macaque population underscores the urgency of effective management programmes. Strategies include preventive measures, such as weeding to limit food sources, habitat modification, and community-based interventions to reduce attractants. Non-lethal deterrents, including visual and auditory scare tactics, trained guard animals, and electric fences, have been implemented to discourage macaques from entering human spaces. Physical barriers, such as fences and buffer zones, provide long-term mitigation but require maintenance and community cooperation. Fertility control, including sterilisation and hormonal contraception, offers a long-term population management solution but presents logistical challenges. Lethal control and capture-relocation, though controversial, remain options for particularly problematic individuals. Additionally, integrating One Health and One Conservation approaches into macaque management allows for a holistic strategy that considers disease risks, ecological balance, and ethical implications. A balanced management plan that incorporates multiple strategies, community participation, and continuous monitoring is crucial for mitigating conflicts and fostering sustainable coexistence between humans and macaques. Full article

Background: Cardiorenal Syndrome (CRS) represents a growing global health challenge due to the increasing prevalence of coexisting kidney and heart disease. The complex pathophysiology of CRS demands an integrated, multidisciplinary approach involving both nephrology and cardiology. However, specialized care models remain limited, leading to fragmented management and suboptimal outcomes. Methods: A Kidney–Heart Outpatient Service was established at "Paolo Giaccone" University Hospital in Palermo in May 2023 to provide coordinated, multidisciplinary care for non-hospitalized patients with CRS. The service involves structured patient assessments, including medical history, physical examinations, laboratory tests, imaging, and a collaborative therapeutic plan formulated by nephrologists and cardiologists. Preliminary patient data were collected and analysed to assess demographic characteristics, comorbidities, and clinical outcomes. Results: Among the first 115 patients evaluated, most were male and over 70 years old. Hypertension (91%) and diabetes were the leading comorbidities, with CKD stage G3b being the most prevalent. Cardiovascular conditions such as atrial fibrillation (18%), prior myocardial infarction (17%), and heart failure (15%) were frequently observed. Three patient deaths occurred, and one progressed to hemodialysis. Conclusions: The Kidney–Heart Outpatient Service represents a novel, patient-centered model for CRS management, aiming to improve clinical outcomes and reduce hospital admissions through multidisciplinary collaboration. Longitudinal follow-up and expanded data collection are essential to validate the long-term efficacy of this approach and refine management strategies for CRS patients. Ongoing research efforts will focus on tracking patient outcomes over extended periods, optimizing therapeutic strategies, and further integrating nephrology and cardiology training. The goal is to establish a sustainable and scalable framework for CRS management that enhances patient care and reduces the healthcare burden. Full article

Median Arcuate Ligament Syndrome, also known as Dunbar’s syndrome, is a rare condition caused by stenosis of the celiac artery (CAS) through the fibrous arch connecting the diaphragmatic branches. It manifests as postprandial abdominal pain, nausea, vomiting, weight loss and increased epigastric tenderness. The condition most commonly affects young females without coexisting vascular comorbidities. Diagnosis is difficult due to the non-specific symptoms, often overlapping with other gastrointestinal diseases. Standard investigations include duplex ultrasound, computed tomography angiography (CTA) and contrast-enhanced magnetic resonance imaging (CE-MRA). Treatment mainly consists of surgical release of the arch ligament, which can be performed by open, laparoscopic or robotic methods. Surgery is often supported by celiac truncal stenting for residual stenosis, which significantly improves vascular flow. Alternative approaches include visceral plexus blocks and novel hybrid techniques, such as a combination of ligament release and endovascular treatment of the celiac trunk. In severe cases, vascular by-passes are recommended. The aim of this paper is to discuss the clinical manifestations, diagnostic possibilities, therapeutic options and directions for further research on MALS from the perspective of a vascular surgeon. It emphasizes the need for a multidisciplinary approach, including collaboration between the surgeon, radiologist, gastroenterologist and psychologist, which enables comprehensive disease management and improved quality of life for patients. In addition, the need for further development of diagnostic and therapeutic methods for early diagnosis and effective treatment was pointed out. Full article