Search Results (683)

Background/Objectives: Commonly known as clubfoot, congenital talipes equinovarus (CTEV) is a structural deformity characterized by cavus, adductus, varus, and equinus (CAVE) positioning of the foot. Idiopathic clubfoot requires prompt treatment to achieve functional, pain-free, and aesthetically normal feet. The Ponseti method is a conservative treatment involving serial manipulation, casting, and Achilles tenotomy, which has demonstrated high success rates. The purpose of this study is to report 10 years of experience using the Ponseti method. Methods: A retrospective and follow-up analysis were conducted with 72 patients (118 feet) with idiopathic clubfoot were treated between 2011 and 2023 who met the minimum follow-up requirement of 12 months (mean follow-up: 54.15 months). The severity of deformities was assessed using the Pirani score. Data collection included demographic details, number of casts, tenotomy procedures, adherence to the Denis Browne brace protocol, and complications. Results: Initial correction of deformities was achieved in all 91 patients (100%). Outcomes were measured using the Ponseti functional scoring system. The average number of casts applied was 9.51 per patient. Percutaneous Achilles tenotomy was performed in 91.21% of cases. Relapse occurred in 22.2% of patients, which required additional treatments. The outcomes were excellent in 77.7% of cases, good in 13.88%, fair in 6.94%, and poor in 1.38%. Discussion: The Ponseti method is effective for idiopathic clubfoot treatment and achieves high rates of initial correction, favorable mid-term outcomes, and minimal complications. These results confirm its reliability and align with previously reported success rates. Full article

This study investigates the influence of different surface treatments (namely, mechanical abrasion and solvent cleaning with isopropyl alcohol and acetone) on the adhesive bonding performance of polylactic acid (PLA) substrates produced by Fused Deposition Modeling (FDM). Pull-off tests revealed that the isopropanol-cleaned specimens achieved the highest bond strength, with an average pull-off value exceeding 8.5 MPa, compared to approximately 5.6 MPa for untreated PLA. Conversely, acetone cleaning resulted in the lowest performance (about 3.5 MPa), while mechanical abrasion yielded intermediate values of about 6 MPa. FTIR analysis confirmed that no chemical reactions occurred, although acetone and abrasion induced significant physical surface changes, unlike isopropanol, which acted as an effective cleaning agent. These findings demonstrate that surface cleanliness plays a dominant role over morphological alterations in enhancing the adhesion of PLA-based 3D-printed joints. Full article

Background/Objectives: Femoral neck fractures are a growing concern due to their increasing incidence in both elderly and younger populations. Preoperative CT scan evaluation is often used for better understanding of fracture patterns of femoral neck fractures that need to be treated using cannulated screws. Methods: The present study retrospectively analyzed 55 patients treated with cannulated screw fixation over seven years. Preoperative CT scans, fracture classification (Garden and Pauwels), and surgical timing were evaluated. Results: All 55 patients were treated with three cannulated screws by nine fellowship-trained surgeons. The average age of the CT-yes group was 54.44 years (SD 15.45), while the average age of the CT-no group was 56.93 (SD 14.95). Differences in age among the two groups were not statistically significant. In 4 patients, the treatment with cannulated screws failed, leading to a subsequent total hip arthroplasty for avascular necrosis (AVN). Three of them belonged to the CT-yes group, while only one belonged to the CT-no group. A statistical analysis showed no significant differences between patients who underwent a CT scan and those who did not have a CT scan and their results (p = 0.282). Results indicate no statistically significant difference in outcomes between patients who underwent a CT scan before the surgical treatment and those who did not, while a well-conducted X-ray assessment is essential and can be sufficient to fully understand and treat most of the fractures. Conclusions: The risks of avascular necrosis and non-union must be considered in the decision-making process regarding the suitable treatment. Early surgery did not significantly improve treatment results, but it is recommended. Fixation with cannulated screws remains a good treatment, especially for some patterns of fractures and younger patients. Given the study’s limitations, including the small sample size and retrospective nature, prospective multicenter studies are warranted to better understand the role of CT scans in optimizing surgical planning and improving patient outcomes. Full article

The increasing demand for renewable energy, coupled with the urgent challenges posed by climate change, has positioned perennial biomass crops (BPGs) as essential and sustainable alternatives for bioenergy production. This study investigated the impact of irrigation regimes on the physiological performance of three BPG species—Arundo donax L., Saccharum spontaneum, and Miscanthus—with a focus on leaf gas exchange (net assimilation rate and transpiration rate) and instantaneous water use efficiency (iWUE) at varying levels of irrigation input, adopting a split-plot experimental design under the Mediterranean climatic conditions of Sicily (Italy). The results clearly showed that A. donax, a C3 species, outperformed the C4 species S. spontaneum and Miscanthus, exhibiting significantly higher stomatal conductance and net photosynthesis, especially under irrigated conditions. S. spontaneum demonstrated the highest iWUE, particularly in rainfed treatments, reflecting its efficient use of water. Miscanthus showed the greatest sensitivity to water stress, with a more pronounced decline in photosynthesis during drought periods. This study accentuated the role of effective water management and genotype selection in optimizing biomass yield and resource efficiency, providing valuable insights for improving crop productivity in Mediterranean and other semi-arid regions. Full article

Background: BAP1 mutation carriers are predisposed to the development of mesothelioma. In mice, there is limited data and controversy about whether germline Bap1 heterozygous mutations alone cause mesothelioma. However, a marked increase in mesothelioma incidence is observed in Bap1-mutant mice upon even minimal asbestos exposures. Methods: To address this issue, we investigated spontaneous mesothelioma development over the lifetime of a large cohort of Bap1-mutant and wild-type (WT) mice across several genetic backgrounds. To determine if the incidence of mesotheliomas in Bap1-mutant mice is significantly increased compared to WT mice, we performed statistical analyses using frequentist and Bayesian frameworks. In the Bayesian framework, to model the probability of disease occurrence, a non-informative prior was used for Bap1-mutant mice, whereas an informative prior for the WT group was derived from historical data spanning the animals’ lifetimes. Multiple strategies were employed to incorporate historical data and infer the informative prior, including a meta-analysis, assuming a consistent probability of mesothelioma across historical datasets, and applying Bayesian meta-analytic predictive priors derived from historical data. Posterior distribution was used, and a comparison was made using odds ratio, risk difference, and risk ratio. Results: Spontaneous mesotheliomas were detected in 2/329 Bap1-mutant and 0/227 WT mice from various genetic backgrounds. Using four statistical approaches, the results did not detect a significant difference in the probabilities of mesothelioma occurrence between Bap1-mutant and WT mice.  Conclusions: Based on these analyses, we cannot conclude that germline Bap1-mutant mice have a significantly increased risk of mesothelioma in the absence of asbestos exposure. Full article

Rye exhibits high diversity in grain coloration among small cereals, which is mainly linked to the presence of colored flavonoids synthesized in the outer layers of the kernel. This variability is not yet sufficiently described from colorimetric, cytological, and biochemical points of view. In this study, the localization of flavonoid pigments, anthocyanins and proanthocyanidins (PAs), was analyzed across different grain tissues in 26 rye lines with identified anthocyanin grain color genes. Grain coloration was objectively characterized using the CIELAB color coordinates and the GrainScan software for image analysis of individual grains. The distribution of anthocyanins and PAs was investigated through light microscopy and matrix-assisted laser desorption/ionization imaging mass spectrometry (MALDI-IMS) on longitudinal and cross sections of the grains. The results revealed that violet-grained lines accumulate anthocyanins in the pericarp, while green-grained lines contain anthocyanins in the aleurone layer. MALDI-IMS confirmed the presence of specific anthocyanins: cyanidins in the pericarp of violet-grained lines and delphinidins in the aleurone layer of green-grained lines. All studied lines, except for the anthocyanin-less vi3 mutants, exhibited PAs in the brown-colored testa. Four main color groups of the rye grains (yellow, green, brown, and violet) could be clearly differentiated using the CIE color coordinate h°. Full article

Background and Objectives: Ankle fractures represent one of the most common injuries to the lower limb, particularly impacting women and the elderly. The coronavirus disease 2019 (COVID-19) pandemic greatly disrupted both the incidence of these fractures and their treatment patterns globally. This retrospective epidemiological study analyzed 1010 cases of ankle fractures treated at the Orthopedics Department of Policlinico University Hospital in Catania from 2018 to 2023. The study aimed to evaluate trends in incidence, patient demographics, fracture types, treatment modalities, and hospital stay across the pre-COVID-19, COVID-19, and post-COVID-19 periods. Materials and Methods: A retrospective observational study was conducted including all patients diagnosed with ankle fractures from 1 January 2018 to 31 December 2023. Data were collected from hospital medical records using ICD-9-CM codes and radiographic classification systems (Danis–Weber, Lauge-Hansen, and AO/OTA). Variables analyzed included demographics, fracture type and side, treatment modality, and hospitalization details. Statistical analyses were performed using t-tests, chi-square tests, and linear regression, with significance set at p < 0.05. Results: In 2020, there was a 31.7% decrease in fracture incidence. Although overall fracture rates rebounded after COVID-19, they did not reach pre-pandemic levels. During the pandemic, trimalleolar fractures increased significantly, occurring more frequently in older women, likely due to bone fragility. The rate of surgical treatments rose during and after the pandemic, with a distinct shift from ORIF to external fixation. Hospital stays were longer, especially for patients with cardiovascular risk factors. Conclusions: The pandemic significantly altered the epidemiology, treatment strategies, and outcomes of ankle fractures. These findings highlight the necessity for adaptable care models and preventive strategies, particularly for vulnerable populations such as older women. Full article

Pre-oxygenation is the key step prior to endotracheal intubation, particularly in a critically ill patient, to prevent life-threatening peri-procedural hypoxemia. This narrative review explores the emerging interest of Non-Invasive Positive Pressure Ventilation (NIPPV) as a pre-oxygenation modality in the intensive care unit (ICU) context. We reviewed data from randomized controlled trials (RCTs) and observational studies published from 2000 to 2024 that compare NIPPV to conventional oxygen therapy and High Flow Nasal Cannula Oxygen (HFNCO). The pathophysiological mechanisms for the successful use of NIPPV, including alveolar recruitment, the decrease of shunting, and the maintenance of functional residual capacity, were reviewed in depth. Existing studies show that NIPPV significantly prolongs the apnea time, reduces the rate of peri-intubation severe hypoxaemia in selected patients and is especially effective for patients with acute hypoxaemic respiratory failure. Nevertheless, appropriate patient selection is still crucial because some diseases can contraindicate or even be harmful with NIPPV. We further discussed the practical aspects of how to use this ventilatory support (the best ventilator settings, which interface, and when to apply it). We lastly discuss unanswered questions and offer suggestions and opportunities for future exploration in guiding the role of NIPPV use in the pre-oxygenation of the critically ill patient requiring emergent airway management. Full article

Changes in lifestyles, as well as the growing attention to healthy nutrition, led to the increasing demand for wines with reduced alcohol content. The reduction in fermentable sugars in the pre-fermentation stage of wine is one of the common methods for the production of wines with lower alcohol content. Viticultural practices such as early harvesting, use of growth regulators, reducing leaf area to limit photosynthetic rate, and pre-harvest irrigation are utilized. Additionally, techniques such as juice dilution, juice filtration with membranes, and the use of enzymes (e.g., glucose oxidase) are also employed in the pre-fermentation stage. This review summarizes and describes the classic and innovative viticultural and pre-fermentation techniques used to reduce the alcohol content and their main impact on the compositional characteristics of wine. Full article

Acute myeloid leukemia (AML), a heterogeneous and aggressive clonal disease, is predominantly observed in older individuals, with a median age at diagnosis of 68–69 years. With the aging population, there is a significant increase in the occurrence of some genetic alterations, including detrimental gene mutations and cytogenetic abnormalities, and a higher incidence of secondary AML (s-AML) and therapy-related AML (t-AML), compared to younger AML patients. Outcomes of AML patients and their response to therapy are associated with the molecular features of AML subtypes and with individual variables. The current criteria for risk classification predict outcomes in younger AML patients treated with intensive chemotherapy but are less predictive for older AML patients treated with lower-intensity treatments. Thus, this review analyzes and discusses the development of new risk stratification models adapted to the study of older AML patients and how these new criteria may significantly contribute to a more rational classification and treatment of older AML patients. Full article

Background/Objective: In recent years, three systematic reviews examining the relationship between frailty and mortality in chronic hemodialysis patients have been published; these reviews employed different inclusion criteria and methodologies, leading to conflicting results. The present study aimed to determine whether frailty is associated with an increased risk of all-cause mortality and hospitalization in patients on maintenance hemodialysis. Methods: The research was conducted in April 2024 using the following databases: MEDLINE via PubMed (1985 to present) and Web of Science Core Collection via Clarivate (1985 to present), with a combination of keywords to capture hemodialysis, frailty, and mortality. Results: We included 23 studies in the analysis, with a total of 10,333 patients (5592 frail and 4741 non-frail). The number of patients in each individual study ranged from 93 to 1652. Adjusted mortality data that accounted for patient characteristics and treatment variables was available from six studies (1034 patients) with a follow-up period of 12 months and revealed an increased all-cause mortality risk in frail patients in the random effects model (pooled OR, 3.28; 95% CI, 1.72–6.29). Moderate heterogeneity was observed in this analysis (Chi² = 14.06, df = 5, (p = 0.02); I² = 64%). Adjusted mortality data that accounted for patient characteristics and treatment variables was available from 21 studies (8757 patients) with any follow-up period and revealed an increased all-cause mortality risk in frail patients in the random effects model (pooled adjusted OR 2.47; 95% CI, 1.85–3.29). Moderate heterogeneity was observed in this analysis (Chi² = 55.1, df = 20, (p < 0.0001); I² = 64%). All-cause hospitalization data was available from 15 studies (6349 patients) with any follow-up period and revealed an increased all-cause hospitalization risk in frail patients in the random effects model (pooled adjusted OR 2.19; 95% CI, 1.72–2.78). Moderate heterogeneity was observed in this analysis (Chi² = 40.9, df = 13; p < 0.0001; I² = 68%). No obvious asymmetry, indicating no clear evidence of publication bias, was observed. Conclusions: Frailty is a significant risk factor for all-cause mortality and all-cause hospitalization in patients on maintenance hemodialysis and presents clinicians with important challenges in routine clinical practice. Full article

Background: Patients with chronic kidney disease (CKD) have a substantially higher risk of developing cognitive impairment (CI) than the general population. Patients with CKD undergoing haemodialysis (HD) treatment also have an elevated risk of developing cerebrovascular and cardiovascular diseases. This study aims to investigate the relationship between the cognitive performance of haemodialysis patients and cerebral and carotid haemodynamic indices. Methods: This study was a non-interventional observational study; the sample consisted of 32 patients (age 65 ± 12 years) undergoing chronic HD treatment. The patients underwent neuropsychological and haemodynamic instrumental investigations, including Supra-Aortic Trunk Echodoppler (SAT) and Transcranial Doppler (TCD). Results: Patients were 17% deficient at Montreal Cognitive Assessment (MoCA), 45% deficient at Frontal Assessment Battery (FAB), 55% deficient at Trail-Making Test-A (TMT-A) and 65% deficient at TMT-B. The TCD investigation detected a decrease in flow (MFV) and an increase in Breath Hold Index (BHI) predominantly in the right cerebral arterial district. The SAT investigation revealed an altered IMT, plaques and the presence of severe carotid stenosis. A strong association between cerebral and carotid indices and cognitive scores was also observed. Correlation analyses reported statistically significant correlations between TMT-A and TMT-B and cerebral flow indices. Conclusions: Among haemodialysis patients, there is a high percentage of cognitive impairment associated and correlated with alterations in cerebral and carotid haemodynamics. Cerebral haemodynamics are a factor to be taken into consideration as a possible pathological mechanism underlying cognitive impairment in haemodialysis. Full article

Background: Displaced proximal humerus fractures (PHFs) in adults represent a common orthopedic challenge, especially in elderly patients with compromised bone quality. Intramedullary nails (IM) and locking plates (LP) are the most widely used fixation techniques, though the literature remains inconclusive regarding their comparative efficacy. Methods: This retrospective cohort study included 187 patients (mean age: 65.4 years) treated surgically for Neer ≥ 2-part proximal humerus fractures at a single tertiary referral center between 2018 and 2023. Patients underwent either IM nailing or LP fixation. Baseline characteristics included age, sex, smoking status, ASA score, trauma mechanism, and bone quality (assessed by the Deltoid Tuberosity Index). Functional outcomes (DASH and Constant–Murley scores), range of motion (ROM), radiographic healing, and complications were evaluated at 1, 3, 6, and 12 months postoperatively. Results were stratified by fracture type (two-, three-, and four-part fractures) and treatment group. Results: At 12 months, no statistically significant differences were found between groups in terms of DASH (p = 0.484) or Constant–Murley scores (p = 0.057). ROM recovery was comparable across all time points. Stratified analysis showed similar outcomes across fracture types. Age, smoking, and bone quality did not significantly influence clinical results. The overall complication rate was 11.8%, with no significant difference between groups. Avascular necrosis and hardware-related issues occurred predominantly in four-part fractures. Conclusions: Both intramedullary nailing and locking plate fixation provided comparable short-term outcomes for displaced PHFs. Functional recovery appeared more dependent on fracture complexity than on the choice of implant. Surgical technique should therefore be selected based on fracture morphology, patient characteristics, and surgeon experience. Full article

Background: Digital breast tomosynthesis (DBT) is a valuable imaging modality for breast cancer detection; however, its interpretation remains time-consuming and subject to inter-reader variability. This study aimed to develop and evaluate two deep learning (DL) models based on transfer learning for the binary classification of breast lesions (benign vs. malignant) using DBT images to support clinical decision-making and risk stratification. Methods: In this retrospective monocentric study, 184 patients with histologically or clinically confirmed benign (107 cases, 41.8%) or malignant (77 cases, 58.2%) breast lesions were included. Each case underwent DBT with a single lesion manually segmented for radiomic analysis. Two convolutional neural network (CNN) architectures—ResNet50 and DenseNet201—were trained using transfer learning from ImageNet weights. A 10-fold cross-validation strategy with ensemble voting was applied. Model performance was evaluated through ROC–AUC, accuracy, sensitivity, specificity, PPV, and NPV. Results: The ResNet50 model outperformed DenseNet201 across most metrics. On the internal testing set, ResNet50 achieved a ROC–AUC of 63%, accuracy of 60%, sensitivity of 39%, and specificity of 75%. The DenseNet201 model yielded a lower ROC–AUC of 55%, accuracy of 55%, and sensitivity of 24%. Both models demonstrated relatively high specificity, indicating potential utility in ruling out malignancy, though sensitivity remained suboptimal. Conclusions: This study demonstrates the feasibility of using transfer learning-based DL models for lesion classification on DBT. While the overall performance was moderate, the results highlight both the potential and current limitations of AI in breast imaging. Further studies and approaches are warranted to enhance model robustness and clinical applicability. Full article

Background/Objectives: Akin osteotomy, in the context of corrective surgery for hallux valgus, is an effective tool available to surgeons. However, few studies have thoroughly investigated the anatomical and technical characteristics to be considered in order to perform an optimal osteotomy. This cross-sectional observational study aims to identify the ideal site for performing Akin osteotomy and to identify the factors that influence its corrective power. Methods: To this end, an analysis was conducted on a random sample of 100 patients (186 feet) who underwent X-rays without surgical treatment. Variations in the width between the metaphysis and diaphysis were measured at five different points. For each cut level, corresponding to wedge bases of 2, 3 and 4 mm, three corrective angles were calculated. In addition, the distance between the cut line and the joint was recorded. Results: The base width ranged from 12.6 to 23.2 mm, showing greater variability in the metaphyseal region. The corrective power of the osteotomy showed wide variability, ranging from 5.9 to 18.4 degrees. Four determining factors emerged: the width of the base, the inclination of the medial cortex, the height at which the cut is made and the thickness of the wedge of bone removed. The data obtained suggest that osteotomy should not be performed less than 10 mm from the joint line to avoid the risk of joint invasion. Conclusions: In conclusion, there is no universally ideal site for performing an Akin osteotomy: the choice depends on the degree of correction desired, which in turn is influenced by the factors identified in the study. Full article