Search Results (4,427)

Background/Objectives: Workplace conflict and aggression pose significant psychosocial risks across diverse professional sectors. This protocol outlines a novel, university-based educational intervention. Developed by a multidisciplinary team from the University Hospital of Pisa, Italy, including occupational physicians and a psychiatrist specializing in work and organizational psychology, its primary purpose is to enhance conflict prevention and crisis management skills. While initially developed and tested within the veterinary sector due to its identified vulnerabilities, the intervention is inherently generalizable to any high-stress professional environment characterized by intense client, customer, or public interactions. Methods: The intervention integrates didactic instruction with active, immersive learning through tailored role-playing scenarios simulating real-world challenging encounters. This study protocol details the structured methodology for evaluating the immediate effectiveness of this training. We are using a specifically developed efficacy scale to assess outcomes. Results: The results demonstrate a significant improvement in all assessed skills from the pre-training to the post-training evaluation. For every item on the scale, the median scores increased, indicating a positive shift in overall group performance. The p-value for each item was <0.001, confirming that the observed improvements were statistically significant. These results demonstrate enhanced conflict resolution skills, improved communication, and an increased sense of self-efficacy among participants. Conclusions: This protocol offers a comprehensive and generalizable approach to addressing workplace psychosocial risks through an innovative educational intervention. A key future goal involves advancing this training methodology by integrating virtual reality (VR) environments with AI-driven avatars for role-playing, aiming to achieve a more realistic and impactful learning experience and sustained behavioral change. Full article

In this study, we present the dating results of an ancient kiln excavated near Ceva (Northern Italy) obtained through combined archaeomagnetic and thermoluminescence approaches. For archaeomagnetic dating, the full geomagnetic field vector (both direction and intensity) was determined. The archaeomagnetic direction was defined through stepwise alternating field demagnetization of in situ-oriented samples of baked clay, and the archaeointensity value was obtained through the Thellier–Coe protocol, including corrections for magnetic anisotropy and cooling rate effects. Thermoluminescence analyses were obtained individually on three samples, using the conventional multiple-aliquot, additive dose procedure. Archaeomagnetic dating was carried out twice, once using the directional results only and once using the full geomagnetic field vector. The independent dating provided by the thermoluminescence analysis was used for comparison, examining the added value of incorporating archaeointensity measurements alongside directional data. The new archaeomagnetic and thermoluminescence results were integrated with previously available radiocarbon dating, using Bayesian modeling for chronological reconstructions. Our results show that the use of archaeointensity in archaeomagnetic dating can be advantageous, better refining the dating. This multidisciplinary strategy underscores the significance of cross-dating in establishing robust chronological frameworks and highlights the crucial role of transdisciplinary methodologies in advancing and refining dating techniques in archaeology. Full article

The emergence of online medical teams (OMTs) as a multidisciplinary approach to addressing complex health issues has gained increasing academic recognition. However, the factors influencing patient adoption of medical advice in this new communication context remain underexplored. This study investigates how multi-doctor involvement in OMTs affects patient adoption of medical advice and examines the moderating roles of leader participation, disciplinary diversity, and illness complexity. The results indicate that multi-doctor involvement positively influences patient adoption of medical advice. This relationship is strengthened by leader participation and disciplinary diversity, while illness complexity exerts no significant moderating effect. As the first study to explore patient adoption of medical advice in the OMT context, these findings advance theoretical understanding and offer practical implications for improving online healthcare services. Full article

Background: Occupational risk prevention is a critical discipline for ensuring safe working conditions and minimizing accidents and occupational diseases. With the rise of artificial intelligence (AI) and machine learning (ML), these approaches are increasingly utilized for predicting and preventing workplace hazards. This systematic review aims to identify, evaluate, and synthesize existing literature on the use of AI algorithms for detecting and predicting hazardous environments and occupational risks in the workplace, focusing on predictive modeling and prevention strategies. Methods: A systematic literature review was conducted following the PRISMA 2020 protocol, with minor adaptations to include conference proceedings and technical reports due to the topic’s emerging and multidisciplinary nature. Searches were performed in IEEE Digital Library, PubMed, Scopus, and Web of Science, with the last search conducted on 1 August 2024. Only peer-reviewed articles published from 2019 onwards and written in English were included. Systematic literature reviews were explicitly excluded. The screening process involved duplicate removal (reducing 209 initial documents to 183 unique ones), a preliminary screening based on titles, abstracts, and keywords (further reducing to 92 articles), and a detailed full-text review. During the full-text review, study quality was assessed using six quality assessment (QA) questions, where articles receiving a total score below 4.5 or 0 in any QA question were excluded. This rigorous process resulted in the selection of 61 relevant articles for quantitative and qualitative analysis. Results: The analysis revealed a growing interest in the field, with a clear upward trend in publications from 2021 to 2023, and a continuation of growth into 2024. The most significant contributions originated from countries such as China, South Korea, and India. Applications primarily focused on high-risk sectors, notably construction, mining, and manufacturing. The most common approach involved the use of visual data captured by cameras, which constituted over 40% of the reviewed studies, processed using deep learning (DL) models, particularly Convolutional Neural Networks (CNNs) and You Only Look Once (YOLO). Conclusions: The study highlights current limitations, including an over-reliance on visual data (especially challenging in low-visibility environments) and a lack of methodological standardization for AI-based risk detection systems. Future research should emphasize the integration of multimodal data (visual, environmental, physiological) and the development of interpretable AI models (XAI) to enhance accuracy, transparency, and trust in hazard detection systems. Addressing long-term societal implications, such as privacy and potential worker displacement, necessitates transparent data policies and robust regulatory frameworks. Full article

Background: Conservative mastectomy with prepectoral breast reconstruction is becoming increasingly widespread and validated in recent years. Today, while aesthetic advantages and improvement in quality-of-life outcomes are widely acknowledged, oncological safety remains subject of debate. There is limited evidence on residual breast tissue after conservative mastectomy, and it still represents an unknown risk for local recurrence. The recent spread of this surgical technique precludes a standardized surgical approach in case of local recurrence of ipsilateral breast cancer, and the lack of evidence in the literature complicates the decision-making process. The objective of this study is to describe the surgical treatment of local relapses for breast cancer patients following conservative mastectomy and prepectoral implant-based reconstruction. Methods: Between January 2018 and May 2024 at a single institution, 648 consecutive patients underwent conservative mastectomy and prepectoral reconstruction as their primary treatment. We identified 12 patients with T1-2 breast cancer who subsequently had histologically confirmed ipsilateral breast cancer recurrence and a local wide excision or radical mastectomy were performed. Each clinical case was discussed in a multidisciplinary meeting to define the most appropriate surgical treatment. At time of diagnosis of recurrence, patients with lymph node metastasis or systemic involvement were excluded from the study. Results: Among 648 consecutive patients who underwent conservative mastectomy, 12 with histologically confirmed ipsilateral breast cancer recurrence were included. The mean interval to recurrence was 43 months (range 10–76 months) from the primary operation. Recurrence sites were as follows: upper outer quadrant in four patients (33.4%), upper inner quadrant in three (25.0%), lower inner quadrant in two (16.6%), lower outer quadrant in one (8.4%), and central quadrant with nipple involvement in two (16.6%). Of the 12 patients, 9 (75%) underwent wide local excision, including 2 who also received partial capsulectomy, while 3 (25%) required radical mastectomy with implant removal. Adjuvant radiation therapy was administered to 6 patients (50%)—5/6 (83.3%) in the excision group and 1/6 (16.7%) in the mastectomy group. No significant differences were observed in distant disease–free survival or overall survival between the two groups. Conclusions: Currently, surgical treatment of ipsilateral breast tumor recurrence following conservative mastectomy and prepectoral breast reconstruction is not reported in the literature, and this study represents the first instance where wide local excision is described. The management of ipsilateral recurrence should be discussed in multidisciplinary meetings and could be performed safely in selected cases, sparing the prosthesis and avoiding radical mastectomy. Full article

Emerging fungal plant pathogens are significant biotic stresses to crops that threaten global food security, biodiversity, and agricultural sustainability. Historically, these pathogens cause devastating crop losses and continue to evolve rapidly due to climate change, international trade, and intensified farming practices. Recent advancements in diagnostic technologies, including remote sensing, sensor-based detection, and molecular techniques, are transforming disease monitoring and detection. These tools, when combined with data mining and big data analysis, facilitate real-time surveillance and early intervention strategies. There is a need for extension and digital advisory services to empower farmers with actionable insights for effective disease management. This manuscript presents an inclusive review of the socioeconomic and historical impacts of fungal plant diseases, the mechanisms driving the emergence of these pathogens, and the pressing need for global surveillance and reporting systems. By analyzing recent advancements and the challenges in the surveillance and diagnosis of fungal pathogens, this review advocates for an integrated, multidisciplinary approach to address the growing threats posed by these emerging fungal diseases. Fostering innovation, enhancing accessibility, and promoting collaboration at both national and international levels are crucial for the agricultural community to protect crops from these emerging biotic stresses, ensuring food security and supporting sustainable farming practices. Full article

Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed condition that significantly increases perioperative morbidity and mortality in both adult and pediatric populations. Its pathophysiology, involving intermittent upper airway obstruction during sleep, poses unique challenges for anesthesiologists due to altered airway anatomy, increased sensitivity to sedatives, and unpredictable ventilatory responses. This comprehensive review summarizes current evidence on the anesthesiologic management of OSA patients, focusing on preoperative screening, risk stratification, intraoperative considerations, and postoperative care. Effective management of OSA requires a multidisciplinary and individualized approach. Preoperative assessment should include validated tools such as STOP-Bang or polysomnography when available. Intraoperative strategies include careful titration of sedatives and opioids, airway protection techniques, and use of short-acting agents. Pediatric patients present specific anatomical and physiological risks, particularly in adenotonsillectomy cases. Postoperative monitoring, especially in the first 24 h, is critical to detect respiratory depression, with CPAP therapy often beneficial in selected patients. Recognizing and appropriately managing OSA in surgical candidates is crucial for improving outcomes and reducing complications. Anesthesiologists should tailor perioperative strategies to the severity of OSA, age group, and type of surgery. Future research should aim to refine predictive tools and establish standardized protocols, particularly in pediatric populations. Full article

A multidisciplinary investigation was conducted in southwestern Sicily, near the seismically active Belice Valley, based on the analysis of morphostructural features. These were observed as open fractures between 2014 and 2017; they were subsequently filled anthropogenically and then reactivated during a seismic swarm in 2019. We generated a seismic event distribution map to analyze the location, magnitude, and depth of earthquakes. This analysis, combined with multitemporal satellite imagery, allowed us to investigate the spatial and temporal relationship between seismic activity and fracture evolution. To investigate the spatial variation in thickness of the superficial cover and to assess the depth to the underlying bedrock or stiffer substratum, 45 Horizontal-to-Vertical Spectral Ratio (HVSR) ambient noise measurements were conducted. This method, which analyzes the resonance frequency of the ground, produced maps of the amplitude, frequency, and vulnerability index of the ground (K_g). By inverting the HVSR curves, constrained by Multichannel Analysis of Surface Waves (MASW) results, a subsurface model was created aimed at supporting the structural interpretation by highlighting variations in sediment thickness potentially associated with fault-controlled subsidence or deformation zones. The surface investigation revealed depressed elliptical deformation zones, where mainly sands outcrop. Grain-size and morphoscopic analyses of sediment samples helped understand the processes generating these shapes and predict future surface deformation. These elliptical shapes recall the liquefaction process. To investigate the potential presence of subsurface fluids that could have contributed to this process, Electrical Resistivity Tomography (ERT) was performed. The combination of the maps revealed a correlation between seismic activity and surface deformation, and the fractures observed were interpreted as inherited tectonic and/or geomorphological structures. Full article

Early-onset colorectal cancer (EOCRC) is emerging as a significant global health concern, particularly among individuals under the age of 50. This alarming trend has coincided with an increase in the consumption of processed foods that often rely heavily on synthetic preservatives. At the same time, these additives play a critical role in ensuring food safety and shelf life. Growing evidence suggests that they may contribute to adverse gut health outcomes, which is a known risk factor in colorectal cancer development. At the same time, synthetic preservatives serve essential roles such as preventing microbial spoilage, maintaining color, and prolonging shelf life. Natural preservatives, on the other hand, not only provide antimicrobial protection but also exhibit antioxidant and anti-inflammatory properties. These contrasting functions form the basis of current discussions on their safety and health implications. Despite their widespread use, the long-term health implications of synthetic preservatives remain inadequately understood. This review synthesizes recent clinical, epidemiological, mechanistic, and toxicological data to examine the potential link between synthetic food preservatives and EOCRC. Particular focus is placed on compounds that have been associated with DNA damage, gut microbiota disruption, oxidative stress, and chronic inflammation, which are the mechanisms that collectively increase cancer risk. In contrast, natural preservatives derived from plants and microbes are gaining attention for their antioxidant, antimicrobial, and possible anti-inflammatory effects. While these alternatives show promise, scientific validation and regulatory approval remain limited. This review highlights the urgent need for more rigorous, long-term human studies and advocates for enhanced regulatory oversight. It advocates for a multidisciplinary approach to developing safer preservation strategies and highlights the importance of public education in making informed dietary choices. Natural preservatives, though still under investigation, may offer a safer path forward in mitigating EOCRC risk and shaping future food and health policies. Full article

Background and Clinical Significance: Arterial and venous thromboses are typically distinct clinical entities, each governed by unique pathophysiological mechanisms. The concurrent manifestation of both, particularly in the setting of massive pulmonary embolism (PE), is exceptionally rare and poses significant diagnostic and therapeutic challenges. Case Presentation: This report describes a 61-year-old male with well-controlled hypertension and type 2 diabetes who developed extensive thromboses involving deep vein thrombosis (DVT) of the right popliteal vein, arterial thrombosis of the left iliac artery, and massive PE. The patient was initially managed conservatively, in accordance with the European Society of Cardiology (ESC) 2019 Guidelines for Acute PE, using unfractionated heparin (UFH), low-molecular-weight heparin, a direct oral anticoagulant (DOAC), and adjunctive therapy. This approach was chosen due to the absence of hemodynamic instability. However, given failed percutaneous revascularization and persistent arterial occlusion, surgical thromboendarterectomy (TEA) was ultimately required. Post hoc genetic testing was prompted by the complex presentation in the absence of classical provoking factors—such as trauma, surgery, malignancy, or antiphospholipid syndrome—consistent with recommendations for selective thrombophilia testing in atypical or severe cases. The analysis revealed four thrombophilia-associated polymorphisms: heterozygous Factor V Leiden (FVL; R506Q genotype), Plasminogen Activator Inhibitor-1 (PAI-1; 4G/5G genotype), Methylenetetrahydrofolate reductase (MTHFR; c.677C > T genotype), and homozygous Angiotensin-Converting Enzyme Insertion/Deletion (ACE I/D; DD genotype). Conclusions: While each variant has been individually associated with thrombotic risk, their co-occurrence in a single patient with simultaneous arterial and venous thromboses has not, to our knowledge, been previously documented. This case underscores the potential for gene–gene interactions to amplify thrombotic risk, even in the presence of variants traditionally considered to confer only modest to moderate risk. It highlights the need for a multidisciplinary approach and raises questions regarding pharmacogenetics, anticoagulation, and future research into cumulative genetic risk in complex thrombotic phenotypes. Full article

Background: Gastrointestinal neuroectodermal tumour (GNET), also known as clear cell sarcoma (CCS) of the gastrointestinal tract, is a rare neural crest-derived malignancy characterized by EWSR1-ATF1 or EWSR1-CREB1 fusions. Due to its rarity, there is limited evidence and no established guidelines for standard management. GNET is aggressive, with high rates of local recurrence, metastasis, and mortality. Case Presentation: We report the case of a 46-year-old woman with a family history of gastrointestinal cancers who was diagnosed in 2020 with an intestinal GNET. She underwent a segmental enterectomy as the first step of multimodal therapy. After three years of follow-up, she developed hepatic and peritoneal metastases. In November 2023, she began combined therapy with the anti-VEGF tyrosine kinase inhibitor cabozantinib and the immune checkpoint inhibitor nivolumab. The patient has maintained stable disease for 18 months with good tolerance and no adverse events. Molecular analysis of the tumour, which showed an EWSR1-CREB1 fusion, supported the selection of targeted therapy and immunotherapy as the preferred treatment approach. Conclusions: Immunotherapy and targeted therapy show promise for GNET/CCS treatment, but clinical standards are lacking, and evidence comes primarily from case reports. Additional data are needed to determine the best sequence and combination of therapies for this very rare disease. Full article

Background: Autoimmune rheumatic diseases, including systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), Sjögren’s syndrome, systemic sclerosis (SSc), and rheumatoid arthritis (RA), pose significant challenges during pregnancy and are associated with increased risks of adverse maternal and fetal outcomes, such as preeclampsia, fetal growth restriction (FGR), miscarriage, and preterm birth. The aim of this review is to synthesize recent evidence on pregnancy-related risks, preconception counseling, and therapeutic strategies for these conditions, with a particular focus on the importance of disease remission, pregnancy-compatible medications, and the selective use of biologics. Methods: A structured narrative review was conducted through a comprehensive PubMed search (2020–2025). Eligible studies addressed maternal–fetal outcomes, therapeutic approaches, and predictive factors in pregnant individuals with autoimmune rheumatic diseases. Results: Pregnancy outcomes have improved with early disease control and multidisciplinary care; however, major challenges persist. These include limited access to novel therapies, underrepresentation of diverse populations in clinical trials, and insufficient data on long-term neonatal outcomes. The strongest predictors of adverse outcomes remain disease activity at conception, specific autoantibody profiles, and systemic organ involvement. Conclusions: Optimal pregnancy outcomes for women with autoimmune rheumatic diseases require coordinated multidisciplinary care, the use of pregnancy-compatible medications, and achievement of prolonged disease remission prior to conception. Further research is needed to close existing knowledge gaps and ensure equitable, high-quality maternal–fetal care. Full article

Background: Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy, with cure rates exceeding 80% due to advancements in treatment protocols and supportive care. However, in children with Down syndrome (DS), ALL (DS-ALL) presents distinct genomic and clinical challenges. These include mutations in Janus kinase 2 (JAK2), neuroblastoma RAS viral oncogene homolog (NRAS), and E1A-binding protein p300 (EP300), as well as cytokine receptor-like factor 2 (CRLF2) rearrangements—such as P2RY8-CRLF2 fusion—and intrachromosomal amplification of chromosome 21 (iAMP21). These aberrations are associated with poor prognosis and increased risk of relapse. The objective of this study was to present a unique DS-ALL case with five concurrent high-risk genomic lesions and to contextualize its management in light of existing literature, emphasizing minimal residual disease (MRD)-guided therapy and supportive care. Case Report and Results: We present the case of a three-year-old boy with DS and B-cell ALL (B-ALL), in whom multiple high-risk genomic features co-occurred. Despite these adverse prognostic markers, the patient achieved complete remission following an intensive high-dose induction protocol. We also discuss therapeutic strategies that aim at balancing individualized treatment approaches with optimized supportive care to reduce toxicity and minimize relapse risk. Conclusions: This case underlines the importance of comprehensive molecular diagnostics, serial MRD monitoring, and personalized multidisciplinary care in DS-ALL. Full article

Osteoporosis is a skeletal disorder characterized by decreased bone strength, which leads to an increased risk of developing fractures. Interestingly, this metabolic disorder is often related to sarcopenia, defined as decreased muscle mass, strength, and function. These two conditions appear to be closely connected, leading to a clinical condition named osteosarcopenia (OS). Aging may explain the link between muscle and bone loss through genetic, mechanical, endocrine, and nutritional factors. Further, aging increases the amount of adipose tissue, often due to sedentary behavior and unbalanced nutritional pattern, leading to a clinical condition defined as osteosarcopenic obesity, characterized by concurrent obesity, sarcopenia, and osteoporosis, where each condition exacerbates the others. Moreover, sarcopenia leads to decreased physical (PA) activity, worsening skeletal homeostasis, and creating a vicious cycle, which increases falls, fracture risk, and disability. This review underscores the importance of a systemic approach, focusing on nutritional therapy integrated with PA and, eventually, pharmacological interventions to efficiently manage (OS). Full article

The effectiveness of breathing interventions on postural alignment, pain reduction, and functional improvement in patients with forward head posture (FHP) and chronic neck pain remains uncertain. Previously conducted randomized controlled trials (RCTs) that involved breathing interventions were identified through searches of the PubMed, Cochrane Library, Web of Science, and Scopus databases. Studies were included if they applied diaphragmatic breathing, breathing muscle training, or feedback breathing exercises for at least 2 weeks to chronic neck pain (duration ≥ 3 months) and/or forward head posture. The craniovertebral angle (CVA), the visual analog scale (VAS), and the neck disability index (NDI) were the primary outcome measures. The results showed that breathing interventions had a moderate effect size in terms of improving the CVA. Limited effects were observed for pain reduction, and improvements in neck disability approached statistical significance. However, despite these positive findings, the overall evidence was rated as ‘very low certainty’ in the GRADE assessment, primarily due to high heterogeneity among studies, limited sample sizes, and the potential for unit-of-analysis errors in diagnosis-based subgroup analyses. Consequently, their overall effectiveness in chronic neck pain was limited. Future research is needed to explore a multidisciplinary approach to neck pain using standardized protocols and larger samples. Full article